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9700 I 20 Frontage Rd Bolton MS 39041-9126 | |
(601) 866-2522 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 9700 I 20 Frontage Rd, Bolton, Mississippi |
Authorized Official Name and Position | Jasmin Chapman (CEO) |
Authorized Official Contact | 6013625321 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3502 W. Northside Drive Jackson MS 39213-4454 Ph: (601) 362-5321 | 9700 I 20 Frontage Rd Bolton MS 39041-9126 Ph: (601) 866-2522 |
NPI Number | 1760414494 |
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Provider Enumeration Date | 07/06/2006 |
Last Update Date | 01/20/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760414494 | NPI | - | NPPES |
04224781 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |