| Interventional Diabetes Center, Llc | |
|
20735 Highway 12 Lexington MS 39095-8266 | |
| (601) 594-7346 | |
| Not Available |
| Full Name | Interventional Diabetes Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20735 Highway 12, Lexington, Mississippi |
| Authorized Official Name and Position | Angel Gooden (ACCOUNTANT) |
| Authorized Official Contact | 6015947346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interventional Diabetes Center, Llc 1060 E County Line Rd # 3a-288 Ridgeland MS 39157-1900 Ph: () - | Interventional Diabetes Center, Llc 20735 Highway 12 Lexington MS 39095-8266 Ph: (601) 594-7346 |
| NPI Number | 1649747825 |
|---|---|
| Provider Enumeration Date | 10/25/2018 |
| Last Update Date | 09/08/2020 |
| Medicare PECOS PAC ID | 1254742935 |
|---|---|
| Medicare Enrollment ID | O20201202000228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649747825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Percy Anderson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1982792198 PECOS PAC ID: 9638148174 Enrollment ID: I20040930000655 |
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