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18295 Emory Road West MS 39192-0000 | |
(662) 834-1321 | |
(601) 815-6301 |
Full Name | |
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Speciality | Clinic/Center |
Location | 18295 Emory Road, West, 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: (662) 834-1321 | 18295 Emory Road West MS 39192-0000 Ph: (662) 834-1321 |
NPI Number | 1194738393 |
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Provider Enumeration Date | 08/15/2006 |
Last Update Date | 05/08/2020 |
Medicare PECOS PAC ID | 1850293036 |
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Medicare Enrollment ID | O20080701000131 |
Identifier | Type | State | Issuer |
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1194738393 | NPI | - | NPPES |
09016279 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |