| A W Watson Elementary School Base Clinic | |
|
880 Anthony St 2045 Highway 61 North Port Gibson MS 39150-2050 | |
| (601) 437-0257 | |
| (601) 437-3944 |
| Full Name | A W Watson Elementary School Base Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 880 Anthony St, Port Gibson, Mississippi |
| Authorized Official Name and Position | Ladonna Davis (CHIEF OPERATING OFFICERS) |
| Authorized Official Contact | 6014373050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A W Watson Elementary School Base Clinic 2045 Highway 61 N P O Box 741 Port Gibson MS 39150-4262 Ph: (601) 437-0257 | A W Watson Elementary School Base Clinic 880 Anthony St 2045 Highway 61 North Port Gibson MS 39150-2050 Ph: (601) 437-0257 |
| NPI Number | 1235394966 |
|---|---|
| Provider Enumeration Date | 07/22/2008 |
| Last Update Date | 12/19/2011 |
| Medicare PECOS PAC ID | 3072412105 |
|---|---|
| Medicare Enrollment ID | O20050620000888 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235394966 | NPI | - | NPPES |
| 03905718 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
Claiborne County Medical Center Rural Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 123 Mccomb Ave, Port Gibson, MS 39150 Phone: 601-437-5141 Fax: 601-437-3782 | |
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