| Kid's Clinic, Pllc | |
|
9325c Highway 19 N Collinsville MS 39325-9219 | |
| (601) 427-2752 | |
| (601) 427-2800 |
| Full Name | Kid's Clinic, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 9325c Highway 19 N, Collinsville, Mississippi |
| Authorized Official Name and Position | Tammy N Henderson (OWNER) |
| Authorized Official Contact | 6014272752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kid's Clinic, Pllc 9325c Highway 19 N Collinsville MS 39325-9219 Ph: (601) 427-2752 | Kid's Clinic, Pllc 9325c Highway 19 N Collinsville MS 39325-9219 Ph: (601) 427-2752 |
| NPI Number | 1477642791 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 06/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477642791 | NPI | - | NPPES |
| 00121471 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 13886 (Mississippi) | Primary |
Ochsner Health Center- Collinsville Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 9097 Collinsville Rd, Collinsville, MS 39325 Phone: 601-626-8874 Fax: 601-626-8592 |