| Extended Care Clinical Services | |
|
724 N Jackson St Brookhaven MS 39601-2460 | |
| (601) 412-4503 | |
| Not Available |
| Full Name | Extended Care Clinical Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 724 N Jackson St, Brookhaven, Mississippi |
| Authorized Official Name and Position | Mallory Mowdy (PRESIDENT) |
| Authorized Official Contact | 6017300602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Extended Care Clinical Services 724 N Jackson St Brookhaven MS 39601-2460 Ph: (601) 833-5255 | Extended Care Clinical Services 724 N Jackson St Brookhaven MS 39601-2460 Ph: (601) 412-4503 |
| NPI Number | 1134741945 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 09/06/2023 |
| Medicare PECOS PAC ID | 5092137844 |
|---|---|
| Medicare Enrollment ID | O20200624000330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134741945 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mallory E Mowdy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427458553 PECOS PAC ID: 0547584104 Enrollment ID: I20150130001594 |
| Provider Name | Melissa J Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609396076 PECOS PAC ID: 4284994856 Enrollment ID: I20180131001427 |
| Provider Name | Cole T Hodges |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932517562 PECOS PAC ID: 6800105669 Enrollment ID: I20180821001741 |
| Provider Name | Tonjia Lang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205548229 PECOS PAC ID: 7618342064 Enrollment ID: I20230417002030 |
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