| |
990 Highway 15 S Laurel MS 39443-0801 | |
(601) 428-0855 | |
(601) 428-1165 |
Full Name | |
---|---|
Speciality | Clinic/center |
Location | 990 Highway 15 S, Laurel, Mississippi |
Authorized Official Name and Position | Thomas Prine (SUPERINTENDENT) |
Authorized Official Contact | 6016495201 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
990 Highway 15 S Laurel MS 39443-0801 Ph: (601) 428-0855 | 990 Highway 15 S Laurel MS 39443-0801 Ph: (601) 428-0855 |
NPI Number | 1578634127 |
---|---|
Provider Enumeration Date | 11/13/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578634127 | NPI | - | NPPES |
01021563 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 84601 (Mississippi) | Primary |
Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 S 11th Ave, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-428-6561 | |
Jefferson Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |