Forever Young Mens Health Clinic Pllc | |
8837 Lorraine Rd Ste B Gulfport MS 39503-5042 | |
(228) 669-7293 | |
Not Available |
Full Name | Forever Young Mens Health Clinic Pllc |
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Speciality | Internal Medicine |
Location | 8837 Lorraine Rd Ste B, Gulfport, Mississippi |
Authorized Official Name and Position | Kendrick Mccarty (OWNER) |
Authorized Official Contact | 2286697293 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Forever Young Mens Health Clinic Pllc 8837 Lorraine Rd Ste B Gulfport MS 39503-5042 Ph: (228) 669-7293 | Forever Young Mens Health Clinic Pllc 8837 Lorraine Rd Ste B Gulfport MS 39503-5042 Ph: (228) 669-7293 |
NPI Number | 1114503190 |
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Provider Enumeration Date | 03/22/2021 |
Last Update Date | 05/11/2022 |
Medicare PECOS PAC ID | 6002294212 |
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Medicare Enrollment ID | O20220531001741 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114503190 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
Provider Name | Kendrick Mccarty |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649621368 PECOS PAC ID: 1153609730 Enrollment ID: I20161102001546 |
Provider Name | Jared J Deloach |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235766304 PECOS PAC ID: 5597196782 Enrollment ID: I20200501001746 |
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