| Lucedale Family Medical Clinic, Llc | |
|
223 Winter St Ste D Lucedale MS 39452-6078 | |
| (601) 791-5012 | |
| (601) 791-5013 |
| Full Name | Lucedale Family Medical Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 223 Winter St Ste D, Lucedale, Mississippi |
| Authorized Official Name and Position | Bridgot Peters (BILLING DIRECTOR) |
| Authorized Official Contact | 2514457618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucedale Family Medical Clinic, Llc 6577 Creel Rd Theodore AL 36582-3857 Ph: (251) 725-8455 | Lucedale Family Medical Clinic, Llc 223 Winter St Ste D Lucedale MS 39452-6078 Ph: (601) 791-5012 |
| NPI Number | 1992409262 |
|---|---|
| Provider Enumeration Date | 03/29/2023 |
| Last Update Date | 05/10/2024 |
| Medicare PECOS PAC ID | 5890157739 |
|---|---|
| Medicare Enrollment ID | O20230809003557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992409262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Norman Mel Parnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184961054 PECOS PAC ID: 7810133055 Enrollment ID: I20130415000121 |
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Community Medical Physicians, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 92 Ratliff St, Lucedale, MS 39452 Phone: 601-947-1330 Fax: 601-947-1331 | |
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