| |
1665 S Green St Tupelo MS 38804-6556 | |
(662) 377-2189 | |
(662) 377-2263 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1665 S Green St, Tupelo, Mississippi |
Authorized Official Name and Position | Gerald Wages (COO) |
Authorized Official Contact | 6623773000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
450 E President Ave Tupelo MS 38801-5599 Ph: (662) 377-4685 | 1665 S Green St Tupelo MS 38804-6556 Ph: (662) 377-2189 |
NPI Number | 1285745885 |
---|---|
Provider Enumeration Date | 08/31/2006 |
Last Update Date | 07/11/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285745885 | NPI | - | NPPES |
09014041 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-2386 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 808 Varsity Dr, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |