| Blackwell's Family Medicine Llc | |
|
107 Ball Ave Tylertown MS 39667-2101 | |
| (601) 303-8264 | |
| Not Available |
| Full Name | Blackwell's Family Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Ball Ave, Tylertown, Mississippi |
| Authorized Official Name and Position | Chrisotpher William Blackwell (OWNER, PROVIDER) |
| Authorized Official Contact | 6013771975 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackwell's Family Medicine Llc 171 Pigott Easterling Rd Tylertown MS 39667-7222 Ph: (601) 303-8264 | Blackwell's Family Medicine Llc 107 Ball Ave Tylertown MS 39667-2101 Ph: (601) 303-8264 |
| NPI Number | 1366003436 |
|---|---|
| Provider Enumeration Date | 06/27/2019 |
| Last Update Date | 03/15/2021 |
| Medicare PECOS PAC ID | 0749616381 |
|---|---|
| Medicare Enrollment ID | O20200130001390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366003436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Christopher W Blackwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982964565 PECOS PAC ID: 3173789047 Enrollment ID: I20120720000179 |
| Provider Name | Lori S Beisel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235683665 PECOS PAC ID: 9537444377 Enrollment ID: I20170318000045 |
| Provider Name | Alvin G Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083138226 PECOS PAC ID: 9739446261 Enrollment ID: I20180720000794 |
| Provider Name | Carla Odom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043827900 PECOS PAC ID: 8527453224 Enrollment ID: I20220316000698 |
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