Provider Demographics
NPI:1669805297
Name:PRIORITY MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:PRIORITY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:N
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-651-6362
Mailing Address - Street 1:601 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3839
Mailing Address - Country:US
Mailing Address - Phone:601-651-6362
Mailing Address - Fax:855-452-4557
Practice Address - Street 1:601 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3839
Practice Address - Country:US
Practice Address - Phone:601-323-1920
Practice Address - Fax:855-452-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty