John C Longest Student Health Center | |
360 Hardy Rd Mississippi State MS 39762 | |
(662) 325-2431 | |
(662) 325-8888 |
Full Name | John C Longest Student Health Center |
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Speciality | Clinic/Center |
Location | 360 Hardy Rd, Mississippi State, Mississippi |
Authorized Official Name and Position | Daniel T Hale (CLINIC BUSINESS ADMINISTRATOR) |
Authorized Official Contact | 6623255895 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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John C Longest Student Health Center Po Box 6338 Mississippi State MS 39762-6338 Ph: (662) 325-2431 | John C Longest Student Health Center 360 Hardy Rd Mississippi State MS 39762 Ph: (662) 325-2431 |
NPI Number | 1225012255 |
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Provider Enumeration Date | 12/02/2005 |
Last Update Date | 09/29/2021 |
Medicare PECOS PAC ID | 1254404320 |
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Medicare Enrollment ID | O20080723000051 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225012255 | NPI | - | NPPES |
09012379 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
Provider Name | Philip Earl Pearson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1366426355 PECOS PAC ID: 9133015050 Enrollment ID: I20040226000315 |
Provider Name | Clifton W Story |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1922064591 PECOS PAC ID: 0244272607 Enrollment ID: I20050525000851 |
Provider Name | Jennifer D Gholson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174588834 PECOS PAC ID: 2567487309 Enrollment ID: I20051011000177 |
Provider Name | Katrina Nichelle Poe |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1245290386 PECOS PAC ID: 2163428780 Enrollment ID: I20061004000508 |
Provider Name | Robert K Collins |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124003785 PECOS PAC ID: 6608944830 Enrollment ID: I20081001000374 |
Provider Name | Michael S Mabry |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447234489 PECOS PAC ID: 4981772019 Enrollment ID: I20081002000514 |
Provider Name | Sheila W Crowley |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407830433 PECOS PAC ID: 4688742729 Enrollment ID: I20081002000527 |
Provider Name | Emily M Sesser |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295042919 PECOS PAC ID: 5395931067 Enrollment ID: I20101119000628 |
Provider Name | Robert Ryan Looney |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1568807196 PECOS PAC ID: 8628203015 Enrollment ID: I20160526000549 |
Provider Name | Laporshia Mcbeth Harris |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710437686 PECOS PAC ID: 9335420157 Enrollment ID: I20170110000022 |
Provider Name | Kennieth C Mccollough |
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Provider Type | Practitioner - Sports Medicine |
Provider Identifiers | NPI Number: 1720243421 PECOS PAC ID: 9830369289 Enrollment ID: I20220715001468 |
Mississippi State University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 325 Hardy Road, Mississippi State, MS 39762 Phone: 662-325-1028 |