| Ellisville Medical Clinic | |
|
1203 Avenue B Ellisville MS 39437-2080 | |
| (601) 477-8553 | |
| (601) 477-9158 |
| Full Name | Ellisville Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1203 Avenue B, Ellisville, Mississippi |
| Authorized Official Name and Position | James T Canizaro (C.F.O. / VICE PRESIDENT) |
| Authorized Official Contact | 6013996139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellisville Medical Clinic 1203 Avenue B Ellisville MS 39437-2080 Ph: (601) 477-8553 | Ellisville Medical Clinic 1203 Avenue B Ellisville MS 39437-2080 Ph: (601) 477-8553 |
| NPI Number | 1942554761 |
|---|---|
| Provider Enumeration Date | 10/31/2012 |
| Last Update Date | 10/31/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942554761 | NPI | - | NPPES |
| 09014135 | Medicaid | MS |
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Ellisville Pediatric Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1203 Ave B, Suite 200, Ellisville, MS 39437 Phone: 601-477-3550 Fax: 601-477-2236 | |
Hattiesburg Clinic Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 822 Main St, Ellisville, MS 39437 Phone: 601-477-2014 Fax: 601-477-9942 | |
Ellisville State School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1101 Hwy 11 S, Ellisville, MS 39437 Phone: 601-477-9384 Fax: 601-477-5700 | |
Fast Pace Mississippi, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 305 Hill St, Ellisville, MS 39437 Phone: 601-800-0118 | |
Ellisville Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1203 Avenue B, Ellisville, MS 39437 Phone: 601-477-8553 Fax: 601-477-9158 |