| |
15024 Martin Luther King Jr Blvd Gulfport MS 39501-8306 | |
(228) 863-9781 | |
(229) 374-0856 |
Full Name | |
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Speciality | Clinic/center - Community Health |
Location | 15024 Martin Luther King Jr Blvd, Gulfport, Mississippi |
Authorized Official Name and Position | Joe M Dawsey (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2283742494 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 475 Biloxi MS 39533-0475 Ph: (228) 374-2494 | 15024 Martin Luther King Jr Blvd Gulfport MS 39501-8306 Ph: (228) 863-9781 |
NPI Number | 1427046408 |
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Provider Enumeration Date | 10/12/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427046408 | NPI | - | NPPES |
9013308 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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