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2520 5th St N Columbus MS 39705-2008 | |
| (662) 244-2561 | |
| (662) 244-2575 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 2520 5th St N, Columbus, Mississippi |
| Authorized Official Name and Position | Gregory M Duckett (SR VP/ CLO) |
| Authorized Official Contact | 9012275233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
350 N Humphreys Blvd Memphis TN 38120-2177 Ph: () - | 2520 5th St N Columbus MS 39705-2008 Ph: (662) 244-2561 |
| NPI Number | 1609963479 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Medicare PECOS PAC ID | 1456244623 |
|---|---|
| Medicare Enrollment ID | O20070306000062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609963479 | NPI | - | NPPES |
| 000020205 | Other | MS | BCBS PROV NUMBER |
| 09013691 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 16253 (Mississippi) | Secondary |
| 273R00000X | Psychiatric Unit | 18871 (Mississippi) | Primary |
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