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1021 Casino Center Dr Robinsonville MS 38664-9708 | |
(662) 357-3264 | |
(662) 357-6092 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1021 Casino Center Dr, Robinsonville, Mississippi |
Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 1021 Casino Center Dr Robinsonville MS 38664-9708 Ph: (662) 357-3264 |
NPI Number | 1861623852 |
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Provider Enumeration Date | 08/07/2009 |
Last Update Date | 10/13/2022 |
Medicare PECOS PAC ID | 1052859402 |
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Medicare Enrollment ID | O20240815003196 |
Identifier | Type | State | Issuer |
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1861623852 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Kavita B Kansagra |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1639321326 PECOS PAC ID: 4385708155 Enrollment ID: I20110315000878 |
Provider Name | Melanie Hill |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033258926 PECOS PAC ID: 1951335058 Enrollment ID: I20240815003469 |