Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 242 Thaggard Rd, Madden, 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 |
---|---|
350 N Humphreys Blvd Memphis TN 38120-2177 Ph: (601) 267-1320 | 242 Thaggard Rd Madden MS 39109 Ph: (601) 267-1320 |
NPI Number | 1649546342 |
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Provider Enumeration Date | 03/27/2012 |
Last Update Date | 09/30/2020 |
Medicare PECOS PAC ID | 7214102961 |
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Medicare Enrollment ID | O20140225001687 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649546342 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |