| Greenwood Comprehensive Medical Clinic | |
|
517 Highway 82 W Greenwood MS 38930-5030 | |
| (662) 455-6767 | |
| (662) 455-1774 |
| Full Name | Greenwood Comprehensive Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 517 Highway 82 W, Greenwood, Mississippi |
| Authorized Official Name and Position | Valencia Patrice Martin (VICE PRESIDENT) |
| Authorized Official Contact | 6624556767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenwood Comprehensive Medical Clinic Po Box 1179 Greenwood MS 38935-1179 Ph: (662) 455-6767 | Greenwood Comprehensive Medical Clinic 517 Highway 82 W Greenwood MS 38930-5030 Ph: (662) 455-6767 |
| NPI Number | 1225172562 |
|---|---|
| Provider Enumeration Date | 02/19/2007 |
| Last Update Date | 05/22/2024 |
| Medicare PECOS PAC ID | 7911192133 |
|---|---|
| Medicare Enrollment ID | O20101115000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225172562 | NPI | - | NPPES |
| 006785238 | Medicaid | MS | |
| 009015021 | Medicaid | MS | |
| 06785238 | Medicaid | MS | |
| 09015021 | Medicaid | MS | |
| 000016353 | Medicaid | MS | |
| 00016353 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 10298 (Mississippi) | Primary |
| 207R00000X | Internal Medicine | 10035 (Mississippi) | Secondary |
| Provider Name | Harold John Wheeler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730270786 PECOS PAC ID: 6800081027 Enrollment ID: I20101203000693 |
| Provider Name | Valencia Patrice Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215028287 PECOS PAC ID: 5395930515 Enrollment ID: I20101220000040 |
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