| Glade Elementary School | |
|
990 Highway 15 S Laurel MS 39443-0801 | |
| (601) 428-0855 | |
| (601) 428-1165 |
| Full Name | Glade Elementary School |
|---|---|
| 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 |
|---|---|
| Glade Elementary School 990 Highway 15 S Laurel MS 39443-0801 Ph: (601) 428-0855 | Glade Elementary School 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 |
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