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17000 Kapalama Dr Pass Christian MS 39571-9761 | |
(228) 467-8700 | |
(228) 467-8799 |
Full Name | |
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Speciality | Family Medicine |
Location | 17000 Kapalama Dr, Pass Christian, Mississippi |
Authorized Official Name and Position | Donald L Wade (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 2284678700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2790 Bay St Louis MS 39521-2790 Ph: (228) 467-8700 | 17000 Kapalama Dr Pass Christian MS 39571-9761 Ph: (228) 467-8700 |
NPI Number | 1356672166 |
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Provider Enumeration Date | 01/18/2010 |
Last Update Date | 03/16/2010 |
Identifier | Type | State | Issuer |
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1356672166 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 11217 (Mississippi) | Primary |
Heartland Pediatrics Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13472 Vidalia Rd, Pass Christian, MS 39571 Phone: 228-344-0039 | |