| Children's Clinic-ecru | |
|
202 Main St Ecru MS 38841-9604 | |
| (662) 489-4345 | |
| Not Available |
| Full Name | Children's Clinic-ecru |
|---|---|
| Speciality | Clinic/Center |
| Location | 202 Main St, Ecru, Mississippi |
| Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
| Authorized Official Contact | 6623773000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Clinic-ecru 202 Main St Ecru MS 38841-9604 Ph: (662) 489-4345 | Children's Clinic-ecru 202 Main St Ecru MS 38841-9604 Ph: (662) 489-4345 |
| NPI Number | 1053728139 |
|---|---|
| Provider Enumeration Date | 07/21/2014 |
| Last Update Date | 07/31/2024 |
| Medicare PECOS PAC ID | 6002895356 |
|---|---|
| Medicare Enrollment ID | O20141013000546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053728139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 16091 (Mississippi) | Primary |
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