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301 Lamar Street Kilmichael MS 39747 | |
(662) 262-5577 | |
(662) 262-5580 |
Full Name | |
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Speciality | Clinic/Center |
Location | 301 Lamar Street, Kilmichael, Mississippi |
Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
Authorized Official Contact | 6623774229 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-3204 | 301 Lamar Street Kilmichael MS 39747 Ph: (662) 262-5577 |
NPI Number | 1912382060 |
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Provider Enumeration Date | 07/29/2015 |
Last Update Date | 01/20/2025 |
Medicare PECOS PAC ID | 6901892421 |
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Medicare Enrollment ID | O20151006000912 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912382060 | NPI | - | NPPES |
25-8615 | Other | MS | MEDICARE RURAL HEALTH |
004629754 | Medicaid | MS | |
C0081 | Other | MS | MEDICARE NON RURAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 13225 (Mississippi) | Primary |