| Lifecore Health Group | |
|
499 Gloster Creek Vlg Suite A-3 Tupelo MS 38801-4600 | |
| (662) 844-1717 | |
| (662) 680-6416 |
| Full Name | Lifecore Health Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 499 Gloster Creek Vlg, Tupelo, Mississippi |
| Authorized Official Name and Position | Rita Berthay (CEO) |
| Authorized Official Contact | 6626404595 |
| 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) 640-4595 | Lifecore Health Group 499 Gloster Creek Vlg Suite A-3 Tupelo MS 38801-4600 Ph: (662) 844-1717 |
| NPI Number | 1679903546 |
|---|---|
| Provider Enumeration Date | 11/13/2013 |
| Last Update Date | 02/27/2020 |
| Medicare PECOS PAC ID | 5193611747 |
|---|---|
| Medicare Enrollment ID | O20140331000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679903546 | NPI | - | NPPES |
| 0000000 | Medicaid | MS | |
| 0000 | Other | MS | BLUE CROSS |
| 000 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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