Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 300 Shows St, Mclain, Mississippi |
Authorized Official Name and Position | Angelique Greer (CEO) |
Authorized Official Contact | 2283742494 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
10467 Corporate Dr Gulfport MS 39503-4634 Ph: (228) 374-2494 | 300 Shows St Mclain MS 39456 Ph: (601) 753-2334 |
NPI Number | 1356444921 |
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Provider Enumeration Date | 09/07/2006 |
Last Update Date | 08/16/2024 |
Medicare PECOS PAC ID | 8628989654 |
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Medicare Enrollment ID | O20170811000279 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356444921 | NPI | - | NPPES |
03330060 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |