| Homeless Clinic | |
|
327 S Gallatin St Jackson MS 39203-3514 | |
| (601) 362-5321 | |
| (601) 364-2600 |
| Full Name | Homeless Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 327 S Gallatin St, Jackson, Mississippi |
| Authorized Official Name and Position | Jasmin R Chapman (CEO) |
| Authorized Official Contact | 6013625321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Homeless Clinic 3502 W Northside Dr Jackson MS 39213-4454 Ph: (601) 362-5321 | Homeless Clinic 327 S Gallatin St Jackson MS 39203-3514 Ph: (601) 362-5321 |
| NPI Number | 1205021946 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 10/29/2010 |
| Medicare PECOS PAC ID | 4183533235 |
|---|---|
| Medicare Enrollment ID | O20110105001087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205021946 | NPI | - | NPPES |
| 09014683 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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