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598 W 11th Ave Lumberton MS 39455-2350 | |
(601) 796-4215 | |
(601) 796-9437 |
Full Name | |
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Speciality | Clinic/Center |
Location | 598 W 11th Ave, Lumberton, Mississippi |
Authorized Official Name and Position | Kaye Ray (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6015458700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P O Box 1729 Lumberton MS 39455-0000 Ph: (601) 796-4215 | 598 W 11th Ave Lumberton MS 39455-2350 Ph: (601) 796-4215 |
NPI Number | 1164499174 |
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Provider Enumeration Date | 03/08/2006 |
Last Update Date | 09/06/2022 |
Medicare PECOS PAC ID | 2466342605 |
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Medicare Enrollment ID | O20091027000709 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164499174 | NPI | - | NPPES |
09014804 | Medicaid | MS | |
2704664 | Other | MS | MS UNITED HEALTH CARE |
C02142 | Other | MS | CAHABA MEDICARE GR NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
Lumberton Public School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 E 10th Ave, Lumberton, MS 39455 Phone: 601-796-2441 |