| |
60024 Olive St Smithville MS 38870-9719 | |
(662) 651-7111 | |
(662) 651-7115 |
Full Name | |
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Speciality | Clinic/center - Community Health |
Location | 60024 Olive St, Smithville, Mississippi |
Authorized Official Name and Position | Marilyn Sumerford (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6626514686 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 205 Smithville MS 38870-0205 Ph: (662) 651-7111 | 60024 Olive St Smithville MS 38870-9719 Ph: (662) 651-7111 |
NPI Number | 1932219524 |
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Provider Enumeration Date | 08/30/2006 |
Last Update Date | 08/09/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932219524 | NPI | - | NPPES |
528902920 | Medicaid | AL | |
09011581 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |