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1129 Highway 35 S Suite 1 Forest MS 39074-8829 | |
(601) 849-6440 | |
(601) 849-1318 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1129 Highway 35 S, Forest, Mississippi |
Authorized Official Name and Position | John P Lee (CHAIRMAN OF THE BOARD) |
Authorized Official Contact | 6018496440 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1129 Highway 35 S Suite 1 Forest MS 39074-8829 Ph: (601) 849-6440 | 1129 Highway 35 S Suite 1 Forest MS 39074-8829 Ph: (601) 849-6440 |
NPI Number | 1154670719 |
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Provider Enumeration Date | 08/29/2012 |
Last Update Date | 05/26/2020 |
Medicare PECOS PAC ID | 0840197232 |
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Medicare Enrollment ID | O20150709000047 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154670719 | NPI | - | NPPES |
13033 | Other | MS | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 13-033 (Mississippi) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Forest Family Practice Clinic Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Medical Ln, Forest, MS 39074 Phone: 601-469-4861 Fax: 601-469-4828 | |
Independent Healthcare Management, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 516 Airport Rd, Forest, MS 39074 Phone: 601-469-4151 Fax: 601-469-3681 | |