| Leland Medical Clinic | |
|
201 Baker Blvd Leland MS 38756 | |
| (662) 686-4121 | |
| (662) 686-4770 |
| Full Name | Leland Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 Baker Blvd, Leland, Mississippi |
| Authorized Official Name and Position | Amy Mcintire (CREDENTIALING) |
| Authorized Official Contact | 6626863956 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leland Medical Clinic 201 Baker Blvd Leland MS 38756 Ph: (662) 686-4121 | Leland Medical Clinic 201 Baker Blvd Leland MS 38756 Ph: (662) 686-4121 |
| NPI Number | 1679673917 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 09/17/2024 |
| Medicare PECOS PAC ID | 4688585805 |
|---|---|
| Medicare Enrollment ID | O20040211000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679673917 | NPI | - | NPPES |
| 200005767 | Medicaid | MS | |
| 09016086 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (Mississippi) | Secondary |
| Provider Name | Heather D Lloyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134164916 PECOS PAC ID: 6507884137 Enrollment ID: I20051102000904 |
| Provider Name | Robert N Suares |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275733636 PECOS PAC ID: 7012053317 Enrollment ID: I20110722000608 |
| Provider Name | Mary Cay B Ely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639477425 PECOS PAC ID: 1759540503 Enrollment ID: I20120314000265 |
| Provider Name | Lacie Arrington Brackeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336490713 PECOS PAC ID: 0547490765 Enrollment ID: I20140307000586 |
Delta Health Alliance Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 Baker Blvd, Leland, MS 38756 Phone: 662-686-4121 | |
Delta Health Alliance, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 Baker Blvd, Leland, MS 38756 Phone: 662-686-4121 Fax: 662-686-4770 | |
Delta Health Center, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 801 N Broad St, Leland, MS 38756 Phone: 662-741-8800 Fax: 662-741-2700 | |
Indianola Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 Baker Blvd, Leland, MS 38756 Phone: 662-686-4121 Fax: 662-686-4770 | |
Leland Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 Baker Blvd, Leland, MS 38756 Phone: 662-686-4121 Fax: 662-686-4770 |