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24345 Highway 15 Union MS 39365-8575 | |
(601) 774-8211 | |
(601) 774-8589 |
Full Name | |
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Speciality | Clinic/Center |
Location | 24345 Highway 15, Union, Mississippi |
Authorized Official Name and Position | Don Larkin Kennedy (REGIONAL CEO) |
Authorized Official Contact | 6017039614 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Dept. 3023 Po Box 1000 Memphis TN 38148-3023 Ph: (601) 213-3010 | 24345 Highway 15 Union MS 39365-8575 Ph: (601) 774-8211 |
NPI Number | 1851643928 |
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Provider Enumeration Date | 10/12/2012 |
Last Update Date | 04/26/2023 |
Medicare PECOS PAC ID | 7214991769 |
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Medicare Enrollment ID | O20130530000564 |
Identifier | Type | State | Issuer |
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1851643928 | NPI | - | NPPES |
009015694 | Medicaid | MS |