| Convenient Care Medical Clinic Llc | |
|
2207 5th St N Columbus MS 39705-2211 | |
| (662) 251-3565 | |
| Not Available |
| Full Name | Convenient Care Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2207 5th St N, Columbus, Mississippi |
| Authorized Official Name and Position | Teresa Marie Sims (OWNER/MANAGER) |
| Authorized Official Contact | 6622417177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Convenient Care Medical Clinic Llc Po Box 9051 Columbus MS 39705-0015 Ph: (662) 251-3565 | Convenient Care Medical Clinic Llc 2207 5th St N Columbus MS 39705-2211 Ph: (662) 251-3565 |
| NPI Number | 1396127221 |
|---|---|
| Provider Enumeration Date | 06/27/2015 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 2062720006 |
|---|---|
| Medicare Enrollment ID | O20150924002454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396127221 | NPI | - | NPPES |
| 01903235 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Mississippi) | Primary |
| Provider Name | Teresa M Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124441571 PECOS PAC ID: 9133346711 Enrollment ID: I20140805001063 |
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