| Goodman Medical Clinic | |
|
470 Goodman Rd E Southaven MS 38671-9557 | |
| (662) 536-3330 | |
| (662) 536-3329 |
| Full Name | Goodman Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 470 Goodman Rd E, Southaven, Mississippi |
| Authorized Official Name and Position | Sunil Malhotra (OWNER / PHYSICIAN) |
| Authorized Official Contact | 6625363330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodman Medical Clinic 470 Goodman Rd E Southaven MS 38671-9557 Ph: (662) 536-3330 | Goodman Medical Clinic 470 Goodman Rd E Southaven MS 38671-9557 Ph: (662) 536-3330 |
| NPI Number | 1982936126 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 06/09/2014 |
| Medicare PECOS PAC ID | 9436373651 |
|---|---|
| Medicare Enrollment ID | O20140610000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982936126 | NPI | - | NPPES |
| 00117366 | Medicaid | MS |
| Provider Name | Sunil Malhotra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841369907 PECOS PAC ID: 2860436425 Enrollment ID: I20050614001146 |
| Provider Name | John E Scallions |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487951042 PECOS PAC ID: 5597929141 Enrollment ID: I20120611000315 |
| Provider Name | Dwight Anthony Dishmon |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1316904048 PECOS PAC ID: 9931165941 Enrollment ID: I20180608000039 |
| Provider Name | Stephen Leschak |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1760430029 PECOS PAC ID: 7315832805 Enrollment ID: I20190819003430 |
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