| Lackey Pediatric Clinic | |
|
1129 Highway 35 S Suite 1 Forest MS 39074-8829 | |
| (601) 849-6440 | |
| (601) 849-1318 |
| Full Name | Lackey Pediatric Clinic |
|---|---|
| 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 |
|---|---|
| Lackey Pediatric Clinic 1129 Highway 35 S Suite 1 Forest MS 39074-8829 Ph: (601) 849-6440 | Lackey Pediatric Clinic 1129 Highway 35 S Suite 1 Forest MS 39074-8829 Ph: (601) 849-6440 |
| NPI Number | 1154670719 |
|---|---|
| Provider Enumeration Date | 08/29/2012 |
| Last Update Date | 05/26/2020 |
| Medicare PECOS PAC ID | 0840197232 |
|---|---|
| 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 |
Checkups Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1309 Highway 35 S, Forest, MS 39074 Phone: 601-469-9999 | |
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Total Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 526 Deerfield Dr, Suite C, Forest, MS 39074 Phone: 601-469-0291 Fax: 601-469-0347 | |
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Community Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 505 Airport Rd Ste B, Forest, MS 39074 Phone: 601-469-4771 Fax: 601-469-4724 |