| |
260 E Main St Centreville MS 39631-4200 | |
(601) 645-5361 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 260 E Main St, Centreville, Mississippi |
Authorized Official Name and Position | Jeremy Chad Netterville (CEO) |
Authorized Official Contact | 6016455221 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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270 W Main Street Centreville MS 39631 Ph: (601) 645-5221 | 260 E Main St Centreville MS 39631-4200 Ph: (601) 645-5361 |
NPI Number | 1023340874 |
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Provider Enumeration Date | 02/04/2010 |
Last Update Date | 02/04/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023340874 | NPI | - | NPPES |
1444669 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
208600000X | Surgery | (* (Not Available)) | Secondary |