Imani Family Medical Clinic, Llc | |
4510 Hanging Moss Rd Jackson MS 39206-3962 | |
(769) 257-5713 | |
(769) 257-5715 |
Full Name | Imani Family Medical Clinic, Llc |
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Speciality | Clinic/Center |
Location | 4510 Hanging Moss Rd, Jackson, Mississippi |
Authorized Official Name and Position | Nkeba I Bell (OWNER) |
Authorized Official Contact | 6014217242 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Imani Family Medical Clinic, Llc 4510 Hanging Moss Rd Jackson MS 39206-3962 Ph: () - | Imani Family Medical Clinic, Llc 4510 Hanging Moss Rd Jackson MS 39206-3962 Ph: (769) 257-5713 |
NPI Number | 1851757785 |
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Provider Enumeration Date | 01/07/2016 |
Last Update Date | 10/27/2016 |
Medicare PECOS PAC ID | 7911297114 |
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Medicare Enrollment ID | O20160531001586 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851757785 | NPI | - | NPPES |
00117713 | Medicaid | MS | |
501534 | Other | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | R803867 (Mississippi) | Primary |
Provider Name | Nkeba Imani Bell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750317400 PECOS PAC ID: 7214001767 Enrollment ID: I20080801000324 |
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