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60017 Highway 23 Smithville MS 38870-9442 | |
(662) 651-4276 | |
(662) 651-4163 |
Full Name | |
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Speciality | Clinic/Center |
Location | 60017 Highway 23, Smithville, Mississippi |
Authorized Official Name and Position | Shelia Cowley (DATA & REPORTING MANAGER) |
Authorized Official Contact | 6626514637 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 305 Smithville MS 38870-0305 Ph: (662) 651-4637 | 60017 Highway 23 Smithville MS 38870-9442 Ph: (662) 651-4276 |
NPI Number | 1972095065 |
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Provider Enumeration Date | 06/04/2018 |
Last Update Date | 06/16/2018 |
Medicare PECOS PAC ID | 4082509492 |
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Medicare Enrollment ID | O20180718003315 |
Identifier | Type | State | Issuer |
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1972095065 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |