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100 South Magnolia Street Edwards MS 39066 | |
(601) 362-5321 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 100 South Magnolia Street, Edwards, Mississippi |
Authorized Official Name and Position | Jasmin Chapman (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 6013625321 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3502 W Northside Dr Jackson MS 39213-4454 Ph: (601) 362-5321 | 100 South Magnolia Street Edwards MS 39066 Ph: (601) 362-5321 |
NPI Number | 1346684826 |
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Provider Enumeration Date | 04/26/2013 |
Last Update Date | 10/02/2013 |
Medicare PECOS PAC ID | 4183533235 |
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Medicare Enrollment ID | O20131230001420 |
Identifier | Type | State | Issuer |
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1346684826 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |