| Gorton Lab And X-ray, Llc | |
|
107 Church St Belzoni MS 39038-3929 | |
| (662) 247-2105 | |
| (662) 247-4849 |
| Full Name | Gorton Lab And X-ray, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 107 Church St, Belzoni, Mississippi |
| Authorized Official Name and Position | Sidney Carlton Gorton (OWNER/PHYSICIAN) |
| Authorized Official Contact | 6622472105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gorton Lab And X-ray, Llc Po Box 633 Belzoni MS 39038-0633 Ph: (662) 247-2105 | Gorton Lab And X-ray, Llc 107 Church St Belzoni MS 39038-3929 Ph: (662) 247-2105 |
| NPI Number | 1225164122 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 11/02/2010 |
| Medicare PECOS PAC ID | 4587751318 |
|---|---|
| Medicare Enrollment ID | O20080825000492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225164122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sidney Carlton Gorton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972572683 PECOS PAC ID: 5698730182 Enrollment ID: I20041123001197 |
| Provider Name | Walter Mack Gorton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528037116 PECOS PAC ID: 0244258309 Enrollment ID: I20080303000649 |
| Provider Name | Emily Aust |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851624928 PECOS PAC ID: 2668668054 Enrollment ID: I20101124000609 |
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