| 4d Healthcare, Llc | |
|
1324 Military Rd Columbus MS 39701-3616 | |
| (662) 630-5001 | |
| Not Available |
| Full Name | 4d Healthcare, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1324 Military Rd, Columbus, Mississippi |
| Authorized Official Name and Position | Tanya S Cockrell (OWNER/OPERATOR) |
| Authorized Official Contact | 6626305001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 4d Healthcare, Llc 1324 Military Rd Columbus MS 39701-3616 Ph: (662) 630-5001 | 4d Healthcare, Llc 1324 Military Rd Columbus MS 39701-3616 Ph: (662) 630-5001 |
| NPI Number | 1164129755 |
|---|---|
| Provider Enumeration Date | 02/14/2023 |
| Last Update Date | 02/14/2023 |
| Certification Date | 02/14/2023 |
| Medicare PECOS PAC ID | 7214301639 |
|---|---|
| Medicare Enrollment ID | O20230324001756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164129755 | NPI | - | NPPES |
| Provider Name | Tanya S Cockrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063838480 PECOS PAC ID: 6709004773 Enrollment ID: I20140904001953 |
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