| Rehoboth Psychiatric Services, Pllc | |
|
357 Towne Center Pl Ste 400 Ridgeland MS 39157-4844 | |
| (888) 561-3380 | |
| (888) 732-6141 |
| Full Name | Rehoboth Psychiatric Services, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 357 Towne Center Pl Ste 400, Ridgeland, Mississippi |
| Authorized Official Name and Position | Clyde E Glenn (OWNER) |
| Authorized Official Contact | 8885613380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rehoboth Psychiatric Services, Pllc Po Bx 1276 Madison MS 39130 Ph: (888) 561-3380 | Rehoboth Psychiatric Services, Pllc 357 Towne Center Pl Ste 400 Ridgeland MS 39157-4844 Ph: (888) 561-3380 |
| NPI Number | 1528265246 |
|---|---|
| Provider Enumeration Date | 06/27/2007 |
| Last Update Date | 11/29/2022 |
| Certification Date | 11/29/2022 |
| Medicare PECOS PAC ID | 5092816512 |
|---|---|
| Medicare Enrollment ID | O20070726000821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528265246 | NPI | - | NPPES |
| 05887866 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 15747 (Mississippi) | Primary |
| Provider Name | Clyde E Glenn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982612164 PECOS PAC ID: 5597667964 Enrollment ID: I20040128000368 |
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