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14430 Main St Coffeeville MS 38922-2590 | |
(662) 675-2500 | |
(662) 675-2501 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 14430 Main St, Coffeeville, Mississippi |
Authorized Official Name and Position | Terry L Varner (ADMINISTRATOR) |
Authorized Official Contact | 6624731411 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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14430 Main St Coffeeville MS 38922-2590 Ph: (662) 675-2500 | 14430 Main St Coffeeville MS 38922-2590 Ph: (662) 675-2500 |
NPI Number | 1639236383 |
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Provider Enumeration Date | 01/02/2007 |
Last Update Date | 02/09/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639236383 | NPI | - | NPPES |
9014717 | Medicaid | MS | |
00120194 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |