Full Name | |
---|---|
Speciality | Clinic/center |
Location | 518 West Dr, Okolona, Mississippi |
Authorized Official Name and Position | Sheila Brockman (CEO) |
Authorized Official Contact | 6624563700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
521 West Dr Okolona MS 38860-1625 Ph: (662) 447-1405 | 518 West Dr Okolona MS 38860-1624 Ph: (662) 447-1405 |
NPI Number | 1922174655 |
---|---|
Provider Enumeration Date | 11/27/2006 |
Last Update Date | 01/18/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922174655 | NPI | - | NPPES |
07728748 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Chickasaw Fmc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 518 West Dr, Okolona, MS 38860 Phone: 662-447-2255 | |