| Greene County Family Medical Clinic | |
|
1017 Jackson Ave Leakesville MS 39451-9105 | |
| (601) 394-2820 | |
| (601) 394-2827 |
| Full Name | Greene County Family Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1017 Jackson Ave, Leakesville, Mississippi |
| Authorized Official Name and Position | Kathy Fender (ADMINISTRATOR) |
| Authorized Official Contact | 6019478181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greene County Family Medical Clinic Po Box 1007 Lucedale MS 39452-1007 Ph: (601) 947-1332 | Greene County Family Medical Clinic 1017 Jackson Ave Leakesville MS 39451-9105 Ph: (601) 394-2820 |
| NPI Number | 1689821126 |
|---|---|
| Provider Enumeration Date | 08/27/2008 |
| Last Update Date | 12/05/2019 |
| Medicare PECOS PAC ID | 5991867954 |
|---|---|
| Medicare Enrollment ID | O20081229000532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689821126 | NPI | - | NPPES |
| 00118573 | Medicaid | MS | |
| 258544 | Other | MS | MEDICARE TRSIPAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 11343 (Mississippi) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Charles A May |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629364070 PECOS PAC ID: 0941470389 Enrollment ID: I20110823000387 |
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