| Greene Family Medical Clinic | |
|
1017 Jackson Ave Leakesville MS 39451-9105 | |
| (601) 394-4135 | |
| (601) 394-4455 |
| Full Name | Greene Family Medical Clinic |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 1017 Jackson Ave, Leakesville, Mississippi |
| Authorized Official Name and Position | Odessa Glynn (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Contact | 6013944135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greene Family Medical Clinic 1017 Jackson Ave Leakesville MS 39451-9105 Ph: (601) 394-4135 | Greene Family Medical Clinic 1017 Jackson Ave Leakesville MS 39451-9105 Ph: (601) 394-4135 |
| NPI Number | 1992982805 |
|---|---|
| Provider Enumeration Date | 01/23/2008 |
| Last Update Date | 07/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992982805 | NPI | - | NPPES |
| 02255270 | Medicaid | MS | |
| 04428516 | Medicaid | MS | |
| 06200741 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 11343 (Mississippi) | Primary |
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