| Gary Road Intermediate School | |
|
7255 Gary Rd Byram MS 39272-8947 | |
| (601) 894-8590 | |
| Not Available |
| Full Name | Gary Road Intermediate School |
|---|---|
| Speciality | Clinic/Center |
| Location | 7255 Gary Rd, Byram, Mississippi |
| Authorized Official Name and Position | Jasmin Chapman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6013645142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Road Intermediate School 3502 W Northside Dr Jackson MS 39213-4454 Ph: (601) 362-5321 | Gary Road Intermediate School 7255 Gary Rd Byram MS 39272-8947 Ph: (601) 894-8590 |
| NPI Number | 1811425291 |
|---|---|
| Provider Enumeration Date | 05/30/2017 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 4183533235 |
|---|---|
| Medicare Enrollment ID | O20170818000752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811425291 | NPI | - | NPPES |
| PENDING | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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