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143 West Howard St Centreville MS 39631 | |
(601) 645-5221 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 143 West Howard St, Centreville, Mississippi |
Authorized Official Name and Position | Brock Slabach (ADMINISTRATOR) |
Authorized Official Contact | 6016455221 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 639 Centreville MS 39631-0639 Ph: (601) 645-5221 | 143 West Howard St Centreville MS 39631 Ph: (601) 645-5221 |
NPI Number | 1184806747 |
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Provider Enumeration Date | 12/05/2007 |
Last Update Date | 12/05/2007 |
Identifier | Type | State | Issuer |
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1184806747 | NPI | - | NPPES |
04577291 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |