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199 Grandstand Place Tupelo MS 38804 | |
(662) 377-7337 | |
(662) 842-1350 |
Full Name | |
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Speciality | Clinic/Center |
Location | 199 Grandstand Place, Tupelo, Mississippi |
Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
Authorized Official Contact | 6623774229 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-2386 | 199 Grandstand Place Tupelo MS 38804 Ph: (662) 377-7337 |
NPI Number | 1649727447 |
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Provider Enumeration Date | 09/09/2016 |
Last Update Date | 01/22/2025 |
Medicare PECOS PAC ID | 9931010600 |
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Medicare Enrollment ID | O20171220002714 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649727447 | NPI | - | NPPES |
007607718 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-2386 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |