| Family Wellness Clinic Llc | |
|
703b Farmer St Port Gibson MS 39150-2319 | |
| (601) 437-5668 | |
| (601) 437-4533 |
| Full Name | Family Wellness Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 703b Farmer St, Port Gibson, Mississippi |
| Authorized Official Name and Position | Tanya S Anderson (MEMBER) |
| Authorized Official Contact | 6014375668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Wellness Clinic Llc Po Box 726 Port Gibson MS 39150-0726 Ph: (601) 437-5668 | Family Wellness Clinic Llc 703b Farmer St Port Gibson MS 39150-2319 Ph: (601) 437-5668 |
| NPI Number | 1457544066 |
|---|---|
| Provider Enumeration Date | 08/27/2007 |
| Last Update Date | 07/09/2021 |
| Medicare PECOS PAC ID | 6608963327 |
|---|---|
| Medicare Enrollment ID | O20071029000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457544066 | NPI | - | NPPES |
| 00122761 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 16897 (Mississippi) | Primary |
| Provider Name | Tanya S Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487708525 PECOS PAC ID: 7517980295 Enrollment ID: I20060109000586 |
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