| Caleb Mountain Climbing Wholistic International Center Llc | |
|
610 Adeline St Ste 1a Hattiesburg MS 39401-3875 | |
| (601) 606-5771 | |
| (800) 489-0211 |
| Full Name | Caleb Mountain Climbing Wholistic International Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 Adeline St Ste 1a, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Bridget Y Tah-clayton (OWNER) |
| Authorized Official Contact | 6016065771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caleb Mountain Climbing Wholistic International Center Llc 610 Adeline St Ste 1a Hattiesburg MS 39401-3875 Ph: (601) 606-5771 | Caleb Mountain Climbing Wholistic International Center Llc 610 Adeline St Ste 1a Hattiesburg MS 39401-3875 Ph: (601) 606-5771 |
| NPI Number | 1487201372 |
|---|---|
| Provider Enumeration Date | 08/24/2019 |
| Last Update Date | 08/24/2019 |
| Medicare PECOS PAC ID | 5890108211 |
|---|---|
| Medicare Enrollment ID | O20210104001216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487201372 | NPI | - | NPPES |
| 00122708 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Bridget Y Tah-clayton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700877537 PECOS PAC ID: 7315946449 Enrollment ID: I20061218000556 |
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