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110 Tchula St Lexington MS 39095-3111 | |
(662) 834-1855 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 110 Tchula St, Lexington, Mississippi |
Authorized Official Name and Position | Jennifer Dawne Holmes (CFO) |
Authorized Official Contact | 6624592603 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1410 Greenwood MS 38935-1410 Ph: (662) 834-1855 | 110 Tchula St Lexington MS 39095-3111 Ph: (662) 834-1855 |
NPI Number | 1841250172 |
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Provider Enumeration Date | 03/23/2006 |
Last Update Date | 05/07/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841250172 | NPI | - | NPPES |
09015105 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Mallory Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17280 Highway 17, Lexington, MS 39095 Phone: 662-834-1857 Fax: 662-834-1859 | |