| Dykes Medical Pllc | |
|
101 Mills St Brookhaven MS 39601-2521 | |
| (601) 833-5608 | |
| (601) 823-6777 |
| Full Name | Dykes Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Mills St, Brookhaven, Mississippi |
| Authorized Official Name and Position | Paul Gerrit Dykes (SOLE MEMBER) |
| Authorized Official Contact | 6016959464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dykes Medical Pllc 102 Loblolly Ln Ne Brookhaven MS 39601-9217 Ph: (601) 695-9464 | Dykes Medical Pllc 101 Mills St Brookhaven MS 39601-2521 Ph: (601) 833-5608 |
| NPI Number | 1477060218 |
|---|---|
| Provider Enumeration Date | 01/02/2018 |
| Last Update Date | 05/02/2018 |
| Medicare PECOS PAC ID | 4880956937 |
|---|---|
| Medicare Enrollment ID | O20180329001650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477060218 | NPI | - | NPPES |
| 00124038 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MS15940 (Mississippi) | Primary |
| Provider Name | Paul Gerrit Dykes |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1861474827 PECOS PAC ID: 8325130750 Enrollment ID: I20101013000434 |
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