| Action Potential, Pllc Dba Bellevue Sports Medicine | |
|
31 Town Center Sq # 200 Hattiesburg MS 39402-7040 | |
| (601) 620-6225 | |
| Not Available |
| Full Name | Action Potential, Pllc Dba Bellevue Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 31 Town Center Sq # 200, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Christopher Penton (OWNER) |
| Authorized Official Contact | 6016206225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Action Potential, Pllc Dba Bellevue Sports Medicine 31 Town Center Sq # 200 Hattiesburg MS 39402-7040 Ph: (601) 620-6225 | Action Potential, Pllc Dba Bellevue Sports Medicine 31 Town Center Sq # 200 Hattiesburg MS 39402-7040 Ph: (601) 620-6225 |
| NPI Number | 1922868314 |
|---|---|
| Provider Enumeration Date | 03/21/2024 |
| Last Update Date | 03/21/2024 |
| Medicare PECOS PAC ID | 6901246636 |
|---|---|
| Medicare Enrollment ID | O20240429002902 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922868314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Christopher Alan Penton |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1265851646 PECOS PAC ID: 7416357587 Enrollment ID: I20210610001742 |
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