| Christ United Medical Clinic | |
|
2750 N Church Ave Louisville MS 39339-2054 | |
| (662) 446-9012 | |
| (662) 446-9432 |
| Full Name | Christ United Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2750 N Church Ave, Louisville, Mississippi |
| Authorized Official Name and Position | Alyssa Cameron Whitehead (FNP-C, CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6624469012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christ United Medical Clinic 9573 Highway 490 Louisville MS 39339-9192 Ph: (662) 446-9012 | Christ United Medical Clinic 2750 N Church Ave Louisville MS 39339-2054 Ph: (662) 446-9012 |
| NPI Number | 1689231367 |
|---|---|
| Provider Enumeration Date | 05/28/2019 |
| Last Update Date | 02/11/2021 |
| Medicare PECOS PAC ID | 5799119780 |
|---|---|
| Medicare Enrollment ID | O20191228000165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689231367 | NPI | - | NPPES |
| R866227 | Other | MS | APRN LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Holman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073576070 PECOS PAC ID: 3476548462 Enrollment ID: I20040419000888 |
| Provider Name | Alyssa C Whitehead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043616543 PECOS PAC ID: 3870810518 Enrollment ID: I20150318000742 |
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