| Indianola Family Medical Group | |
|
122 E Baker St Indianola MS 38751-2451 | |
| (662) 887-2212 | |
| (662) 887-1279 |
| Full Name | Indianola Family Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 E Baker St, Indianola, Mississippi |
| Authorized Official Name and Position | Jim Woods (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6628872212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indianola Family Medical Group 122 E Baker St Indianola MS 38751-2451 Ph: (662) 887-2212 | Indianola Family Medical Group 122 E Baker St Indianola MS 38751-2451 Ph: (662) 887-2212 |
| NPI Number | 1245248699 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6709771637 |
|---|---|
| Medicare Enrollment ID | O20050808001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245248699 | NPI | - | NPPES |
| 09015873 | Medicaid | MS | |
| 08904503 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Mississippi) | Primary |
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