| Bmc Leake Walnut Grove Primary Care | |
|
110 Park St Walnut Grove MS 39189-6526 | |
| (601) 267-1400 | |
| Not Available |
| Full Name | Bmc Leake Walnut Grove Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 Park St, Walnut Grove, Mississippi |
| Authorized Official Name and Position | Gregory M Duckett (SR VP/CLO) |
| Authorized Official Contact | 9012275233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bmc Leake Walnut Grove Primary Care 350 N Humphreys Blvd Memphis TN 38120-2177 Ph: (601) 267-1400 | Bmc Leake Walnut Grove Primary Care 110 Park St Walnut Grove MS 39189-6526 Ph: (601) 267-1400 |
| NPI Number | 1548310782 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 09/30/2020 |
| Medicare PECOS PAC ID | 7214102961 |
|---|---|
| Medicare Enrollment ID | O20111215000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548310782 | NPI | - | NPPES |
| 0123601 | Medicaid | MS | |
| 0115309 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Walnut Grove Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 199 Rimmer St, Walnut Grove, MS 39189 Phone: 601-253-2733 Fax: 601-253-2733 | |
Walnut Grove Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Park St, Walnut Grove, MS 39189 Phone: 601-253-0173 Fax: 601-253-0176 |