Caledonia Community Clinic, Llc | |
171 South St Caledonia MS 39740-8587 | |
(662) 855-0080 | |
Not Available |
Full Name | Caledonia Community Clinic, Llc |
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Speciality | Family Medicine |
Location | 171 South St, Caledonia, Mississippi |
Authorized Official Name and Position | Lisa Jordan Hudson (FNP-C) |
Authorized Official Contact | 6622513451 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Caledonia Community Clinic, Llc Po Box 217 Caledonia MS 39740-0217 Ph: (662) 251-3451 | Caledonia Community Clinic, Llc 171 South St Caledonia MS 39740-8587 Ph: (662) 855-0080 |
NPI Number | 1619552130 |
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Provider Enumeration Date | 03/16/2021 |
Last Update Date | 03/16/2021 |
Medicare PECOS PAC ID | 8426466913 |
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Medicare Enrollment ID | O20210422000543 |
Identifier | Type | State | Issuer |
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1619552130 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Lisa Jordan Hudson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528577012 PECOS PAC ID: 1456616259 Enrollment ID: I20180529000617 |
Provider Name | Erin Whitley Lee |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760028294 PECOS PAC ID: 4284029588 Enrollment ID: I20220324000221 |
Pioneer Family Medical Of Caledonia Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 771 Main St, Caledonia, MS 39740 Phone: 662-356-4621 |