| Baz Family Medical Clinic | |
|
4310 Chicot St Pascagoula MS 39581-4700 | |
| (717) 421-5490 | |
| Not Available |
| Full Name | Baz Family Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4310 Chicot St, Pascagoula, Mississippi |
| Authorized Official Name and Position | Jeanette Shabazz (PRESIDEN) |
| Authorized Official Contact | 7174215490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baz Family Medical Clinic 7922 Longwood Dr Gautier MS 39553-2629 Ph: (717) 421-5490 | Baz Family Medical Clinic 4310 Chicot St Pascagoula MS 39581-4700 Ph: (717) 421-5490 |
| NPI Number | 1508353384 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 04/17/2018 |
| Medicare PECOS PAC ID | 6800141367 |
|---|---|
| Medicare Enrollment ID | O20180625001723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508353384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R885984 (Mississippi) | Primary |
| Provider Name | Jeanette Shabazz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073916771 PECOS PAC ID: 9537483458 Enrollment ID: I20150126001369 |
| Provider Name | Shekina T Dillon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265918445 PECOS PAC ID: 2567709603 Enrollment ID: I20190228000174 |
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