| |
1101 Saint Joseph St Waveland MS 39576-2528 | |
(228) 374-2494 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1101 Saint Joseph St, Waveland, 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 | 1101 Saint Joseph St Waveland MS 39576-2528 Ph: (228) 374-2494 |
NPI Number | 1669137444 |
---|---|
Provider Enumeration Date | 11/05/2021 |
Last Update Date | 08/16/2024 |
Medicare PECOS PAC ID | 8628989654 |
---|---|
Medicare Enrollment ID | O20220412000204 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669137444 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |