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1102 Rose St Prentiss MS 39474-5200 | |
(601) 792-4276 | |
(601) 792-2947 |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 1102 Rose St, Prentiss, Mississippi |
Authorized Official Name and Position | Richard Andrew Woodard (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6012882892 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1102 Rose St Prentiss MS 39474-5200 Ph: (601) 792-4276 | 1102 Rose St Prentiss MS 39474-5200 Ph: (601) 792-4276 |
NPI Number | 1003194747 |
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Provider Enumeration Date | 07/29/2011 |
Last Update Date | 12/20/2011 |
Identifier | Type | State | Issuer |
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1003194747 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |