| |
232 Starlyn Ave New Albany MS 38652-2428 | |
(662) 486-5122 | |
(662) 486-5123 |
Full Name | |
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Speciality | Clinic/Center |
Location | 232 Starlyn Ave, New Albany, Mississippi |
Authorized Official Name and Position | Steven Collier (CEO) |
Authorized Official Contact | 8703473300 |
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 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | 232 Starlyn Ave New Albany MS 38652-2428 Ph: (662) 486-5122 |
NPI Number | 1396439899 |
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Provider Enumeration Date | 06/07/2023 |
Last Update Date | 02/13/2024 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20230913001261 |
Identifier | Type | State | Issuer |
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1396439899 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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