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201a Magnolia St Vaiden MS 39176-5644 | |
(601) 496-5400 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 201a Magnolia St, Vaiden, Mississippi |
Authorized Official Name and Position | Jeffrey Grimsley (ASST. CFO) |
Authorized Official Contact | 6019859181 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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201a Magnolia St Vaiden MS 39176-5644 Ph: (662) 496-5400 | 201a Magnolia St Vaiden MS 39176-5644 Ph: (601) 496-5400 |
NPI Number | 1841727971 |
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Provider Enumeration Date | 05/19/2017 |
Last Update Date | 05/19/2017 |
Medicare PECOS PAC ID | 1850293036 |
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Medicare Enrollment ID | O20170707000292 |
Identifier | Type | State | Issuer |
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1841727971 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |