| East-end Family Medical Clinic, Llc | |
|
140 North St Cleveland MS 38732-2744 | |
| (662) 545-4674 | |
| (662) 545-4715 |
| Full Name | East-end Family Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 140 North St, Cleveland, Mississippi |
| Authorized Official Name and Position | Cassandra Latasha Shepard (FNP/ADMINISTRATOR) |
| Authorized Official Contact | 6625454674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East-end Family Medical Clinic, Llc 1500 N Bayou Rd Cleveland MS 38732-9723 Ph: (662) 721-8036 | East-end Family Medical Clinic, Llc 140 North St Cleveland MS 38732-2744 Ph: (662) 545-4674 |
| NPI Number | 1487118733 |
|---|---|
| Provider Enumeration Date | 01/30/2019 |
| Last Update Date | 01/17/2024 |
| Medicare PECOS PAC ID | 2860734506 |
|---|---|
| Medicare Enrollment ID | O20190430001478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487118733 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Cassandra L Shepard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144748898 PECOS PAC ID: 6800153867 Enrollment ID: I20171129000700 |
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