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300 Yazoo Street Lexington MS 39095 | |
(662) 834-5000 | |
(662) 834-5003 |
Full Name | |
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Speciality | Clinic/Center |
Location | 300 Yazoo Street, Lexington, 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 |
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Post Office Box 479 Lexington MS 39095-0479 Ph: (662) 834-1857 | 300 Yazoo Street Lexington MS 39095 Ph: (662) 834-5000 |
NPI Number | 1740624881 |
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Provider Enumeration Date | 04/19/2013 |
Last Update Date | 07/21/2016 |
Medicare PECOS PAC ID | 9739074501 |
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Medicare Enrollment ID | O20130826000934 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740624881 | NPI | - | NPPES |
00474061 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
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 | |