| Express Care Of Fulton | |
|
202 Interchange Dr Fulton MS 38843-6011 | |
| (662) 862-9040 | |
| (662) 862-9091 |
| Full Name | Express Care Of Fulton |
|---|---|
| Speciality | Clinic/Center |
| Location | 202 Interchange Dr, Fulton, Mississippi |
| Authorized Official Name and Position | Laura L Curbow (OFFICE MANAGER) |
| Authorized Official Contact | 6628629040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Express Care Of Fulton 202 Interchange Dr 204 Interchange Drive Fulton MS 38843-6011 Ph: (662) 862-9040 | Express Care Of Fulton 202 Interchange Dr Fulton MS 38843-6011 Ph: (662) 862-9040 |
| NPI Number | 1780890517 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 01/14/2010 |
| Medicare PECOS PAC ID | 7012947484 |
|---|---|
| Medicare Enrollment ID | O20050816000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780890517 | NPI | - | NPPES |
| 09015389 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tara B Enlow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336266550 PECOS PAC ID: 8022048404 Enrollment ID: I20050817000758 |
| Provider Name | John W White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457364606 PECOS PAC ID: 1658289277 Enrollment ID: I20060403000487 |
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