| Family Med 101, Inc | |
|
101 Mimosa St Booneville MS 38829-2911 | |
| (662) 720-4919 | |
| (662) 720-4980 |
| Full Name | Family Med 101, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Mimosa St, Booneville, Mississippi |
| Authorized Official Name and Position | Felesha D Perrigo (OWNER/NURSE PRACTITIONER) |
| Authorized Official Contact | 6627204919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Med 101, Inc Po Box 60 Booneville MS 38829-0060 Ph: (662) 720-4919 | Family Med 101, Inc 101 Mimosa St Booneville MS 38829-2911 Ph: (662) 720-4919 |
| NPI Number | 1902997059 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 11/09/2017 |
| Medicare PECOS PAC ID | 6305845298 |
|---|---|
| Medicare Enrollment ID | O20070319000340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902997059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R763457 (Mississippi) | Primary |
| Provider Name | Felesha D Perrigo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518959584 PECOS PAC ID: 8123062783 Enrollment ID: I20050614001152 |
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