| Family Medical Clinic Of Houston | |
|
1002 E Madison St Ste 2 Houston MS 38851-2428 | |
| (662) 456-5008 | |
| (662) 456-5404 |
| Full Name | Family Medical Clinic Of Houston |
|---|---|
| Speciality | Clinic/Center |
| Location | 1002 E Madison St Ste 2, Houston, Mississippi |
| Authorized Official Name and Position | Sheila Brockman (CEO) |
| Authorized Official Contact | 6624563700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Clinic Of Houston Po Box 432 Houston MS 38851-0432 Ph: (662) 456-5008 | Family Medical Clinic Of Houston 1002 E Madison St Ste 2 Houston MS 38851-2428 Ph: (662) 456-5008 |
| NPI Number | 1083721732 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 01/18/2024 |
| Medicare PECOS PAC ID | 0042102352 |
|---|---|
| Medicare Enrollment ID | O20080728000469 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083721732 | NPI | - | NPPES |
| 09014528 | Medicaid | MS | |
| C02044 | Other | MS | MEDICARE PART B GROUP |
| 253422 | Other | MS | TRISPAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 12-296 (Mississippi) | Primary |
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