Hattiesburg Clinic Pa | |
1238 Highway 42 Sumrall MS 39482 | |
(601) 758-3100 | |
(601) 758-3060 |
Full Name | Hattiesburg Clinic Pa |
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Speciality | Family Medicine |
Location | 1238 Highway 42, Sumrall, Mississippi |
Authorized Official Name and Position | Bryan N Batson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6012646000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Hattiesburg Clinic Pa 415 S 28th Ave Hattiesburg MS 39401-7246 Ph: (601) 579-5463 | Hattiesburg Clinic Pa 1238 Highway 42 Sumrall MS 39482 Ph: (601) 758-3100 |
NPI Number | 1790871853 |
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Provider Enumeration Date | 10/05/2006 |
Last Update Date | 02/22/2021 |
Medicare PECOS PAC ID | 5193706794 |
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Medicare Enrollment ID | O20100930079468 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790871853 | NPI | - | NPPES |
00081762 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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