Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 260 Highway 18, Utica, Mississippi |
Authorized Official Name and Position | Jasmin Chapman (CEO) |
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 | 260 Highway 18 Utica MS 39175 Ph: (601) 885-8765 |
NPI Number | 1881628741 |
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Provider Enumeration Date | 07/10/2006 |
Last Update Date | 07/09/2009 |
Medicare PECOS PAC ID | 4183533235 |
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Medicare Enrollment ID | O20030331000006 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881628741 | NPI | - | NPPES |
02884328 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |