| Meditelecare Of Mississippi Llc | |
|
645 Lakeland East Dr Ste 101 Flowood MS 39232-9099 | |
| (860) 788-6404 | |
| Not Available |
| Full Name | Meditelecare Of Mississippi Llc |
|---|---|
| Speciality | Psychologist |
| Location | 645 Lakeland East Dr Ste 101, Flowood, Mississippi |
| Authorized Official Name and Position | Teresa P Trojanowski (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 8607886404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of Mississippi Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of Mississippi Llc 645 Lakeland East Dr Ste 101 Flowood MS 39232-9099 Ph: (860) 788-6404 |
| NPI Number | 1467951939 |
|---|---|
| Provider Enumeration Date | 02/09/2018 |
| Last Update Date | 07/16/2019 |
| Medicare PECOS PAC ID | 9234493123 |
|---|---|
| Medicare Enrollment ID | O20210226000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467951939 | NPI | - | NPPES |
| Provider Name | Lauren Gavron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104307925 PECOS PAC ID: 0547505950 Enrollment ID: I20181212003005 |
| Provider Name | Christopher Staples |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992001762 PECOS PAC ID: 7810300407 Enrollment ID: I20210226000558 |
| Provider Name | Carey Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962944926 PECOS PAC ID: 3678841202 Enrollment ID: I20210303000043 |
| Provider Name | Ann M Hetzel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922327105 PECOS PAC ID: 8123336948 Enrollment ID: I20210818004257 |
| Provider Name | Michelle Segerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134554132 PECOS PAC ID: 2769614882 Enrollment ID: I20220615002757 |
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