Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
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 |
---|---|
Po Box 432 Houston MS 38851-0432 Ph: (662) 476-1716 | 518 West Dr Okolona MS 38860-1624 Ph: (662) 447-6170 |
NPI Number | 1134236870 |
---|---|
Provider Enumeration Date | 08/25/2006 |
Last Update Date | 01/18/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134236870 | NPI | - | NPPES |
253417 | Other | MS | TRISPAN |
C02044 | Other | MS | MEDICARE PART B GROUP |
09014527 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (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 | |