Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 5334 Dale Dr, Marion, Mississippi |
Authorized Official Name and Position | Don Larkin Kennedy (REGIONAL CEO) |
Authorized Official Contact | 6017039614 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Dept 3019, P O Box 1000 Memphis TN 38148-3019 Ph: (601) 213-3010 | 5334 Dale Dr Marion MS 39342-9604 Ph: (601) 703-0130 |
NPI Number | 1669812962 |
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Provider Enumeration Date | 07/01/2013 |
Last Update Date | 04/26/2023 |
Medicare PECOS PAC ID | 5991985012 |
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Medicare Enrollment ID | O20130828000753 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669812962 | NPI | - | NPPES |
000939715 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |