| Dr. Arenia C. Mallory Community Health Center, Inc. | |
|
276 Nissan Parkway, Building C Suite 100 Canton MS 39046 | |
| (601) 855-5275 | |
| (601) 859-3253 |
| Full Name | Dr. Arenia C. Mallory Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 276 Nissan Parkway, Building C, Canton, Mississippi |
| Authorized Official Name and Position | Clyde Rozell Chapman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6628341857 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Arenia C. Mallory Community Health Center, Inc. Po Box 479 Lexington MS 39095-0479 Ph: (662) 834-1857 | Dr. Arenia C. Mallory Community Health Center, Inc. 276 Nissan Parkway, Building C Suite 100 Canton MS 39046 Ph: (601) 855-5275 |
| NPI Number | 1013034636 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 08/29/2024 |
| Medicare PECOS PAC ID | 9739074501 |
|---|---|
| Medicare Enrollment ID | O20101123000478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013034636 | NPI | - | NPPES |
| 09015635 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Magnolia Medical Clinics Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1171 Hart St, Canton, MS 39046 Phone: 601-859-9888 Fax: 601-859-9004 | |
Everycare Express Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 162 Feather Ln, Suite E, Canton, MS 39046 Phone: 601-859-0140 | |
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