| Lara Clement, Pllc | |
|
1308 Highway 51 Madison MS 39110-7205 | |
| (601) 853-4343 | |
| Not Available |
| Full Name | Lara Clement, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1308 Highway 51, Madison, Mississippi |
| Authorized Official Name and Position | Lara Teal Clement (MEDICAL DOCTOR) |
| Authorized Official Contact | 6014152711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lara Clement, Pllc 710 Newitt Vick Dr Vicksburg MS 39183-8746 Ph: (601) 415-2711 | Lara Clement, Pllc 1308 Highway 51 Madison MS 39110-7205 Ph: (601) 853-4343 |
| NPI Number | 1902501083 |
|---|---|
| Provider Enumeration Date | 03/30/2023 |
| Last Update Date | 03/30/2023 |
| Medicare PECOS PAC ID | 3173998531 |
|---|---|
| Medicare Enrollment ID | O20230417002498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902501083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lara J Teal Clement |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912933672 PECOS PAC ID: 9032198858 Enrollment ID: I20040715000949 |
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