Full Name | |
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Speciality | Family Medicine |
Location | 108 Main Street, Arcola, Mississippi |
Authorized Official Name and Position | Iris Stacker (CEO) |
Authorized Official Contact | 6627252264 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 4739 Greenville MS 38704-4739 Ph: (662) 378-3783 | 108 Main Street Arcola MS 38722 Ph: (662) 378-3783 |
NPI Number | 1841841210 |
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Provider Enumeration Date | 09/26/2019 |
Last Update Date | 11/14/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841841210 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |