| Lifecore Health Group | |
|
2434 S Eason Blvd Tupelo MS 38804-6942 | |
| (662) 844-1717 | |
| (662) 680-6416 |
| Full Name | Lifecore Health Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 2434 S Eason Blvd, Tupelo, Mississippi |
| Authorized Official Name and Position | Steven Stall (CFO) |
| Authorized Official Contact | 6628441717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifecore Health Group 2434 S Eason Blvd Tupelo MS 38804-6942 Ph: (662) 844-1717 | Lifecore Health Group 2434 S Eason Blvd Tupelo MS 38804-6942 Ph: (662) 844-1717 |
| NPI Number | 1548413628 |
|---|---|
| Provider Enumeration Date | 11/03/2008 |
| Last Update Date | 03/20/2014 |
| Medicare PECOS PAC ID | 5193611747 |
|---|---|
| Medicare Enrollment ID | O20040223000473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548413628 | NPI | - | NPPES |
| 04329807 | Medicaid | MS | |
| 07453596 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Herman T Palmer |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1811088115 PECOS PAC ID: 3274421656 Enrollment ID: I20040308000704 |
| Provider Name | Susan Duffie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871674713 PECOS PAC ID: 6204724685 Enrollment ID: I20040308000766 |
| Provider Name | Ross E Collins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508893074 PECOS PAC ID: 2961474440 Enrollment ID: I20040806000594 |
| Provider Name | Maxie Lerone Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427018613 PECOS PAC ID: 2466406798 Enrollment ID: I20050309000456 |
| Provider Name | Janet B Richey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427206556 PECOS PAC ID: 3779651567 Enrollment ID: I20081007000262 |
| Provider Name | Susan K Schnuerer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518037662 PECOS PAC ID: 4082708052 Enrollment ID: I20081124000430 |
| Provider Name | Teresa N Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649361973 PECOS PAC ID: 4789859315 Enrollment ID: I20111209000672 |
| Provider Name | Michael D Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962597708 PECOS PAC ID: 9234378670 Enrollment ID: I20130617000147 |
| Provider Name | Edith W Faulkner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134460736 PECOS PAC ID: 8921159120 Enrollment ID: I20130701000096 |
| Provider Name | Alena B. Tyre-littlejohn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578654851 PECOS PAC ID: 7214179217 Enrollment ID: I20130803000069 |
| Provider Name | Lisa D Foley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801009592 PECOS PAC ID: 2466671110 Enrollment ID: I20151215001554 |
| Provider Name | Jennifer K. Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356707400 PECOS PAC ID: 9436457082 Enrollment ID: I20160414000707 |
| Provider Name | Olamide Alabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821453648 PECOS PAC ID: 2769772227 Enrollment ID: I20160613000806 |
| Provider Name | Katherine Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790138873 PECOS PAC ID: 8820383961 Enrollment ID: I20160829000427 |
| Provider Name | Ashley Nacole Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548783509 PECOS PAC ID: 0840565529 Enrollment ID: I20171005001656 |
| Provider Name | Colby Blake Ponder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023572294 PECOS PAC ID: 8426390824 Enrollment ID: I20190506001159 |
| Provider Name | Amy Neighbors |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306853932 PECOS PAC ID: 9133455033 Enrollment ID: I20190731000113 |
| Provider Name | Andrea Paige Pounds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275182818 PECOS PAC ID: 1254662802 Enrollment ID: I20191011001082 |
| Provider Name | Pat L Cummings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073777850 PECOS PAC ID: 2860829249 Enrollment ID: I20200225000324 |
| Provider Name | Jennifer Gail Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164083747 PECOS PAC ID: 4486083201 Enrollment ID: I20200330003717 |
| Provider Name | Jennifer Earl Rossi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184208449 PECOS PAC ID: 0042611337 Enrollment ID: I20210624000047 |
| Provider Name | Yvette Monique Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326655614 PECOS PAC ID: 3072905017 Enrollment ID: I20220124002934 |
| Provider Name | Dawn Marie Begner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053041251 PECOS PAC ID: 2365825007 Enrollment ID: I20220813000268 |
| Provider Name | Kendal Gaines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487371563 PECOS PAC ID: 6406227131 Enrollment ID: I20230117002139 |
| Provider Name | Lea Anne Hillhouse |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245384213 PECOS PAC ID: 4082067624 Enrollment ID: I20240130002487 |
| Provider Name | Stephanie Sweda |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336802735 PECOS PAC ID: 9436595055 Enrollment ID: I20240306000647 |
South Madison Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1040a S. Madison St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
Nmmc Ekg Interpretations Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 830 S Gloster St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
North Mississippi Neurosurgical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801 Phone: 662-377-5700 Fax: 662-377-5720 | |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 | |
Advanced Wound Center Professionals Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 S Gloster St, 1st Floor East Tower, Tupelo, MS 38801 Phone: 662-377-2395 Fax: 662-377-2397 |