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117 S 11th Ave Laurel MS 39440-4312 | |
(601) 425-3033 | |
(601) 422-0431 |
Full Name | |
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Speciality | Clinic/Center |
Location | 117 S 11th Ave, Laurel, Mississippi |
Authorized Official Name and Position | Rashad N Ali (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6014253033 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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713 Lomax Ave Waynesboro MS 39367-2556 Ph: (601) 425-3033 | 117 S 11th Ave Laurel MS 39440-4312 Ph: (601) 425-3033 |
NPI Number | 1477919603 |
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Provider Enumeration Date | 01/04/2016 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 9638163348 |
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Medicare Enrollment ID | O20160302001415 |
Identifier | Type | State | Issuer |
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1477919603 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (Mississippi) | Primary |
Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 S 11th Ave, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-428-6561 | |
Jefferson Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |