| |
500 Silver Cross Dr Ste A Brookhaven MS 39601-2304 | |
(601) 757-7787 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 500 Silver Cross Dr Ste A, Brookhaven, Mississippi |
Authorized Official Name and Position | Lauren Berry (COO) |
Authorized Official Contact | 6014055394 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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300 Concourse Blvd Ste 106 Ridgeland MS 39157-2085 Ph: () - | 500 Silver Cross Dr Ste A Brookhaven MS 39601-2304 Ph: (601) 757-7787 |
NPI Number | 1689441867 |
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Provider Enumeration Date | 12/07/2023 |
Last Update Date | 07/18/2024 |
Medicare PECOS PAC ID | 6800334749 |
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Medicare Enrollment ID | O20240809003602 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689441867 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Lauren Griffin Berry |
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Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1659119188 PECOS PAC ID: 8224578448 Enrollment ID: I20240913002222 |
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