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239 Bowling Green Road Lexington MS 39095 | |
(662) 834-1321 | |
(601) 815-6301 |
Full Name | |
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Speciality | Clinic/Center |
Location | 239 Bowling Green Road, Lexington, Mississippi |
Authorized Official Name and Position | Jeffrey Grimsley (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6018158732 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2500 N State St Jackson MS 39216-4500 Ph: () - | 239 Bowling Green Road Lexington MS 39095 Ph: (662) 834-1321 |
NPI Number | 1538179585 |
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Provider Enumeration Date | 08/09/2006 |
Last Update Date | 05/08/2020 |
Medicare PECOS PAC ID | 1850293036 |
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Medicare Enrollment ID | O20040428001158 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538179585 | NPI | - | NPPES |
06300013 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Mallory Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17280 Highway 17, Lexington, MS 39095 Phone: 662-834-1857 Fax: 662-834-1859 | |