| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 901 Forest Street, Shelby, Mississippi |
| Authorized Official Name and Position | Vanella Campbell (CEO) |
| Authorized Official Contact | 6623985004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1507 Clarksdale MS 38614-1507 Ph: (662) 398-5004 | 901 Forest Street Shelby MS 38774 Ph: (662) 398-5004 |
| NPI Number | 1598904377 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 02/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598904377 | NPI | - | NPPES |
| 09586879 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Mississippi) | Primary |
Making Moves In The Community, Incorporated Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1305 Martin Luther King, Shelby, MS 38774 Phone: 662-402-1098 | |
Spann Senses, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 905 North Broadway, Shelby, MS 38774 Phone: 662-545-7243 | |