Full Name | |
---|---|
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 |
---|---|
202 Main St Ecru MS 38841-9604 Ph: (662) 489-4345 | 202 Main St Ecru MS 38841-9604 Ph: (662) 489-4345 |
NPI Number | 1053728139 |
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Provider Enumeration Date | 07/21/2014 |
Last Update Date | 07/31/2024 |
Medicare PECOS PAC ID | 6002895356 |
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Medicare Enrollment ID | O20141013000546 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053728139 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 16091 (Mississippi) | Primary |