| Endocrinology Consultants, Pllc | |
|
670 Crossover Rd Tupelo MS 38801-4944 | |
| (662) 844-8414 | |
| (662) 844-8275 |
| Full Name | Endocrinology Consultants, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 670 Crossover Rd, Tupelo, Mississippi |
| Authorized Official Name and Position | Mark D Shepherd (DIRECTOR) |
| Authorized Official Contact | 6628448414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endocrinology Consultants, Pllc Po Box 4087 Tupelo MS 38803-4087 Ph: (662) 844-8414 | Endocrinology Consultants, Pllc 670 Crossover Rd Tupelo MS 38801-4944 Ph: (662) 844-8414 |
| NPI Number | 1376559880 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 11/28/2007 |
| Medicare PECOS PAC ID | 7012917743 |
|---|---|
| Medicare Enrollment ID | O20070103000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376559880 | NPI | - | NPPES |
| 09778731 | Medicaid | MS | |
| CH0754 | Other | MS | RAILROAD MEDICARE GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (Mississippi) | Primary |
| Provider Name | Mark Shepherd |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1760499867 PECOS PAC ID: 3375543002 Enrollment ID: I20100830000348 |
| Provider Name | Leonil Ganlim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962512590 PECOS PAC ID: 9335333624 Enrollment ID: I20101101000361 |
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