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126 W Central Ave Petal MS 39465-2314 | |
(601) 296-2552 | |
(601) 296-2397 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 126 W Central Ave, Petal, Mississippi |
Authorized Official Name and Position | Barry Monday (ADMIN) |
Authorized Official Contact | 6012962552 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 17708 Hattiesburg MS 39404-7708 Ph: (601) 296-2552 | 126 W Central Ave Petal MS 39465-2314 Ph: (601) 296-2552 |
NPI Number | 1033475967 |
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Provider Enumeration Date | 04/04/2012 |
Last Update Date | 04/04/2012 |
Identifier | Type | State | Issuer |
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1033475967 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |