| Park Medical Clinic | |
|
47 S Main St Pontotoc MS 38863-2823 | |
| (662) 499-2802 | |
| Not Available |
| Full Name | Park Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 47 S Main St, Pontotoc, Mississippi |
| Authorized Official Name and Position | Christopher Park (OWNER/PHYSICIAN) |
| Authorized Official Contact | 6623974597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Medical Clinic Po Box 507 Pontotoc MS 38863-0507 Ph: (662) 308-7045 | Park Medical Clinic 47 S Main St Pontotoc MS 38863-2823 Ph: (662) 499-2802 |
| NPI Number | 1831710623 |
|---|---|
| Provider Enumeration Date | 05/03/2020 |
| Last Update Date | 02/18/2024 |
| Medicare PECOS PAC ID | 6204258064 |
|---|---|
| Medicare Enrollment ID | O20200624001003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831710623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Christopher L Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710181078 PECOS PAC ID: 1557448610 Enrollment ID: I20080414000516 |
| Provider Name | Leslie Kay Eaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417504796 PECOS PAC ID: 7416386925 Enrollment ID: I20200404000343 |
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