| At Home Primary Care Of Ms Llc | |
|
295 Archie Smith Rd Hattiesburg MS 39402-9322 | |
| (601) 207-1009 | |
| Not Available |
| Full Name | At Home Primary Care Of Ms Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 295 Archie Smith Rd, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Lisa Deloris Slade (NURSE PRACTITIONER) |
| Authorized Official Contact | 6012701009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| At Home Primary Care Of Ms Llc 295 Archie Smith Rd Hattiesburg MS 39402-9322 Ph: (601) 207-1009 | At Home Primary Care Of Ms Llc 295 Archie Smith Rd Hattiesburg MS 39402-9322 Ph: (601) 207-1009 |
| NPI Number | 1801515622 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 1355726191 |
|---|---|
| Medicare Enrollment ID | O20220915001310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801515622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lisa D Slade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013080027 PECOS PAC ID: 0244334571 Enrollment ID: I20070327000300 |
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