Mississippicare129 | |
2173 S Lamar Blvd Oxford MS 38655-5223 | |
(662) 234-6553 | |
(662) 234-6555 |
Full Name | Mississippicare129 |
---|---|
Speciality | Clinic/Center |
Location | 2173 S Lamar Blvd, Oxford, Mississippi |
Authorized Official Name and Position | Steven Collier (CEO) |
Authorized Official Contact | 8703473204 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Mississippicare129 Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | Mississippicare129 2173 S Lamar Blvd Oxford MS 38655-5223 Ph: (662) 234-6553 |
NPI Number | 1124661855 |
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Provider Enumeration Date | 10/25/2019 |
Last Update Date | 10/09/2020 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20200302000479 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124661855 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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