Family Care Of Main Street | |
701 S Holly Ave Collins MS 39428-3894 | |
(601) 765-2746 | |
(601) 765-6660 |
Full Name | Family Care Of Main Street |
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Speciality | Clinic/Center |
Location | 701 S Holly Ave, Collins, Mississippi |
Authorized Official Name and Position | Kirstie Evans (CFO) |
Authorized Official Contact | 6017656711 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Family Care Of Main Street 210 Main St Collins MS 39428-6188 Ph: (601) 765-2746 | Family Care Of Main Street 701 S Holly Ave Collins MS 39428-3894 Ph: (601) 765-2746 |
NPI Number | 1518260330 |
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Provider Enumeration Date | 12/16/2010 |
Last Update Date | 12/16/2010 |
Medicare PECOS PAC ID | 4183517253 |
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Medicare Enrollment ID | O20040203000816 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518260330 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Terry D Ford |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1912922949 PECOS PAC ID: 2961398102 Enrollment ID: I20040225000436 |
Provider Name | Becky J Mercier |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083726491 PECOS PAC ID: 0244216166 Enrollment ID: I20040629001303 |
Provider Name | Charles L Mccullouch |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1710964754 PECOS PAC ID: 8729066923 Enrollment ID: I20040713001089 |
Provider Name | Leigh P Drace |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013064245 PECOS PAC ID: 3375512916 Enrollment ID: I20040929001220 |
Provider Name | Evan J Pickus |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1073545554 PECOS PAC ID: 3375501471 Enrollment ID: I20041221000439 |
Provider Name | Roger L Nunez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1932132669 PECOS PAC ID: 4284692617 Enrollment ID: I20041230000547 |
Provider Name | Jeffrey J Mitchell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942234232 PECOS PAC ID: 1557311032 Enrollment ID: I20050124000631 |
Provider Name | Sherri A Robertson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790894335 PECOS PAC ID: 8921042318 Enrollment ID: I20050616000410 |
Provider Name | Toikus Westbrook |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1285738468 PECOS PAC ID: 1153348362 Enrollment ID: I20061009000262 |
Provider Name | Robin D Greene - Brownlee |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215035985 PECOS PAC ID: 8628078425 Enrollment ID: I20061229000186 |
Provider Name | Herbert Floyd |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1457345365 PECOS PAC ID: 8426154923 Enrollment ID: I20070430000363 |
Provider Name | Mary S Watkins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245323914 PECOS PAC ID: 3072610229 Enrollment ID: I20070522000691 |
Provider Name | George E Gillespie |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1124117171 PECOS PAC ID: 4082713151 Enrollment ID: I20070702000147 |
Provider Name | Chad D Caraway |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205052164 PECOS PAC ID: 9436232170 Enrollment ID: I20080219000084 |
Provider Name | Marshall J Stout |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1073555454 PECOS PAC ID: 3072682707 Enrollment ID: I20080520000765 |
Provider Name | Kiley Mclendon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780849109 PECOS PAC ID: 7113095407 Enrollment ID: I20081014000670 |
Provider Name | William B Gibboney |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225202864 PECOS PAC ID: 1153481916 Enrollment ID: I20081124000457 |
Provider Name | Andrea M Bruce |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1295739894 PECOS PAC ID: 8426113135 Enrollment ID: I20090212000523 |
Provider Name | Jennifer B Boutwell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184958969 PECOS PAC ID: 5698815439 Enrollment ID: I20091229000564 |
Provider Name | Jonathan C Sledge |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1982868782 PECOS PAC ID: 9638214042 Enrollment ID: I20100309000597 |
Provider Name | Harpreet Sood |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336398510 PECOS PAC ID: 6002932191 Enrollment ID: I20100927000395 |
Provider Name | Jennifer R Leggett-hudson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801100037 PECOS PAC ID: 3476748427 Enrollment ID: I20101116000588 |
Provider Name | Haresh M Patel |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1659339125 PECOS PAC ID: 1658275219 Enrollment ID: I20110321000581 |
Provider Name | Jessica A Garner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982913729 PECOS PAC ID: 2466635438 Enrollment ID: I20110329000471 |
Provider Name | Patricia A Bullock |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679862817 PECOS PAC ID: 1557530128 Enrollment ID: I20110816000741 |
Provider Name | Jeremy Paul Wade |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538494489 PECOS PAC ID: 6406029487 Enrollment ID: I20111108000436 |
Provider Name | Karen R Pitts |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467729293 PECOS PAC ID: 7113193251 Enrollment ID: I20111220000631 |
Provider Name | Christa Kay Staples |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740319839 PECOS PAC ID: 1759549025 Enrollment ID: I20120217000036 |
Provider Name | Brian K Padgett |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750677704 PECOS PAC ID: 3173787702 Enrollment ID: I20120612000442 |
Provider Name | Terri Bickham |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457668162 PECOS PAC ID: 7911131768 Enrollment ID: I20131009001742 |
Provider Name | Tyler W Thompson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639501380 PECOS PAC ID: 5496980880 Enrollment ID: I20131018001537 |
Provider Name | Erin K Hines |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952742736 PECOS PAC ID: 3779712799 Enrollment ID: I20140214000449 |
Provider Name | Wendell T Carney |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043638869 PECOS PAC ID: 2961628805 Enrollment ID: I20140729002044 |
Provider Name | Nicole Lott |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861809402 PECOS PAC ID: 8628297959 Enrollment ID: I20140917002925 |
Provider Name | Lacey Blakeney |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326457151 PECOS PAC ID: 7214254010 Enrollment ID: I20150316000467 |
Provider Name | Norman E Jenkins |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992196331 PECOS PAC ID: 9830416908 Enrollment ID: I20150330001257 |
Provider Name | Michael R Ambrose |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427023696 PECOS PAC ID: 3971406729 Enrollment ID: I20150427001574 |
Provider Name | David J Mulvaney |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1578509659 PECOS PAC ID: 0446294565 Enrollment ID: I20150501001415 |
Provider Name | Melissa Coulson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235581513 PECOS PAC ID: 8729371737 Enrollment ID: I20160728002112 |
Provider Name | Benjamin Michael Illich |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1508277609 PECOS PAC ID: 4981929015 Enrollment ID: I20170208000775 |
Provider Name | Christie L Kellar |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184161457 PECOS PAC ID: 6901183094 Enrollment ID: I20170427000044 |
Provider Name | Bryan G Bennett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255731287 PECOS PAC ID: 3870815731 Enrollment ID: I20171213002890 |
Provider Name | Natalie R Keyes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285144584 PECOS PAC ID: 6608137971 Enrollment ID: I20180301000326 |
Provider Name | Crystal P Mcnabb |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326565763 PECOS PAC ID: 5193086403 Enrollment ID: I20180301001879 |
Provider Name | Terri Byrd |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285135228 PECOS PAC ID: 4284983875 Enrollment ID: I20180815000482 |
Provider Name | Twylia M. Aultman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912483405 PECOS PAC ID: 3072863000 Enrollment ID: I20180912001218 |
Provider Name | Laura J Davis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548756810 PECOS PAC ID: 1850644618 Enrollment ID: I20181024000654 |
Provider Name | Sarah D Clark |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922582220 PECOS PAC ID: 3779836325 Enrollment ID: I20181029000792 |
Provider Name | Felicia S Stewart |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477011161 PECOS PAC ID: 9830431444 Enrollment ID: I20190501001619 |
Provider Name | Bria Goff |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457904989 PECOS PAC ID: 4688906183 Enrollment ID: I20191104000414 |
Provider Name | Anna Fails |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154945848 PECOS PAC ID: 5193147007 Enrollment ID: I20200623002065 |
Provider Name | Ariale Nelson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790319945 PECOS PAC ID: 8527481845 Enrollment ID: I20200706000808 |
Provider Name | Destiny D Epting |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710598230 PECOS PAC ID: 5193141539 Enrollment ID: I20200817002458 |
Provider Name | Samantha C Givens |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497356562 PECOS PAC ID: 8820401888 Enrollment ID: I20210112000722 |
Provider Name | Brandon Smith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639746001 PECOS PAC ID: 0547662025 Enrollment ID: I20210706003239 |
Provider Name | Jeremy Todd Unger |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1881198075 PECOS PAC ID: 2163772484 Enrollment ID: I20210920000924 |
Provider Name | Weaton M Middleton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467022939 PECOS PAC ID: 3678970571 Enrollment ID: I20210920002548 |
Family Care Express Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3275 Hwy 49, Suite E, Collins, MS 39428 Phone: 601-765-6711 Fax: 601-765-2808 | |
Carver Middle School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 Carver Drive, Collins, MS 39428 Phone: 601-545-8700 Fax: 601-450-2493 | |
Covington County Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 S Holly Ave, Collins, MS 39428 Phone: 601-765-6711 Fax: 601-698-0112 | |
Covington County Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1207 S Fir Ave, Collins, MS 39428 Phone: 601-419-7468 | |
Collins Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 704 Fifth Street, Collins, MS 39428 Phone: 601-765-4414 Fax: 601-765-9141 | |
Covington County Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Highway 35, Collins, MS 39428 Phone: 601-837-7380 | |
Hopewell Elementary School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 824 Hopewell Rd, Collins, MS 39428 Phone: 601-545-8700 Fax: 601-450-2493 |