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607c N Irwin Ave Ocilla GA 31774-5009 | |
(229) 468-5020 | |
(229) 468-5024 |
Full Name | |
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Speciality | Clinic/Center |
Location | 607c N Irwin Ave, Ocilla, Georgia |
Authorized Official Name and Position | Robert B Tucker (CEO) |
Authorized Official Contact | 2294689166 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 749 Ocilla GA 31774-0749 Ph: (229) 468-9166 | 607c N Irwin Ave Ocilla GA 31774-5009 Ph: (229) 468-5020 |
NPI Number | 1356709646 |
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Provider Enumeration Date | 02/02/2016 |
Last Update Date | 11/20/2024 |
Medicare PECOS PAC ID | 1951395920 |
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Medicare Enrollment ID | O20190828002078 |
Identifier | Type | State | Issuer |
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1356709646 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Irwin Specialty Centers Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 710 N Irwin Ave, Ocilla, GA 31774 Phone: 229-468-3800 | |