| Ellisville State School | |
|
1101 Hwy 11 S Ellisville MS 39437-4444 | |
| (601) 477-9384 | |
| (601) 477-5700 |
| Full Name | Ellisville State School |
|---|---|
| Speciality | Clinic/center |
| Location | 1101 Hwy 11 S, Ellisville, Mississippi |
| Authorized Official Name and Position | Suzie Lassiter (DIRECTOR) |
| Authorized Official Contact | 6014779384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellisville State School 1101 Hwy 11 S Ellisville MS 39437-4444 Ph: (601) 477-9384 | Ellisville State School 1101 Hwy 11 S Ellisville MS 39437-4444 Ph: (601) 477-9384 |
| NPI Number | 1568468080 |
|---|---|
| Provider Enumeration Date | 06/21/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568468080 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | C00638 (Mississippi) | Primary |
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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 | |
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 |