| Indianola Wellness Clinic, Llc | |
|
131 Main St Indianola MS 38751-2849 | |
| (662) 303-3743 | |
| Not Available |
| Full Name | Indianola Wellness Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 131 Main St, Indianola, Mississippi |
| Authorized Official Name and Position | Kajuandra K Chandler (MANAGER/OWNER) |
| Authorized Official Contact | 6623033743 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indianola Wellness Clinic, Llc 108 Whittington Dr Indianola MS 38751-3434 Ph: (662) 303-3743 | Indianola Wellness Clinic, Llc 131 Main St Indianola MS 38751-2849 Ph: (662) 303-3743 |
| NPI Number | 1508393000 |
|---|---|
| Provider Enumeration Date | 05/15/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508393000 | NPI | - | NPPES |
| 03321871 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 901379 (Mississippi) | Primary |
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