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270 W Main Street Centreville MS 39631 | |
(601) 645-5221 | |
(601) 645-5873 |
Full Name | |
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Speciality | Family Medicine |
Location | 270 W Main Street, Centreville, Mississippi |
Authorized Official Name and Position | Jacquelyn Richoux (CFO) |
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 | 270 W Main Street Centreville MS 39631 Ph: (601) 645-5221 |
NPI Number | 1730342643 |
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Provider Enumeration Date | 07/10/2008 |
Last Update Date | 07/10/2008 |
Identifier | Type | State | Issuer |
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1730342643 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
208600000X | Surgery | (* (Not Available)) | Secondary |