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17280 Highway 17 South Lexington MS 39095 | |
(662) 834-1857 | |
(662) 834-4937 |
Full Name | |
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Speciality | Clinic/Center |
Location | 17280 Highway 17 South, Lexington, Mississippi |
Authorized Official Name and Position | Clyde Rozell Chapman (INTERIM 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 |
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Po Box 479 Lexington MS 39095-0479 Ph: (662) 834-1857 | 17280 Highway 17 South Lexington MS 39095 Ph: (662) 834-1857 |
NPI Number | 1740308873 |
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Provider Enumeration Date | 03/27/2007 |
Last Update Date | 07/29/2015 |
Medicare PECOS PAC ID | 9739074501 |
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Medicare Enrollment ID | O20101123000529 |
Identifier | Type | State | Issuer |
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1740308873 | NPI | - | NPPES |
09013975 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mallory Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17280 Highway 17, Lexington, MS 39095 Phone: 662-834-1857 Fax: 662-834-1859 | |