Lauderdale Medical Group | |
11 E Jefferson St Pontotoc MS 38863-2807 | |
(662) 419-1260 | |
Not Available |
Full Name | Lauderdale Medical Group |
---|---|
Speciality | Clinic/Center |
Location | 11 E Jefferson St, Pontotoc, Mississippi |
Authorized Official Name and Position | Jessica Anne Lauderdale (OWNER) |
Authorized Official Contact | 6624896041 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Lauderdale Medical Group 131 Emberwood Ct Tupelo MS 38801-7861 Ph: (662) 419-1260 | Lauderdale Medical Group 11 E Jefferson St Pontotoc MS 38863-2807 Ph: (662) 419-1260 |
NPI Number | 1689456527 |
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Provider Enumeration Date | 10/16/2023 |
Last Update Date | 03/22/2024 |
Medicare PECOS PAC ID | 2365890175 |
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Medicare Enrollment ID | O20231204002265 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689456527 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Jessica A Lauderdale |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093095523 PECOS PAC ID: 4082901228 Enrollment ID: I20170111000566 |
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