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17280 Highway 17 Lexington MS 39095-6614 | |
(662) 834-1857 | |
(662) 834-0531 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 17280 Highway 17, Lexington, Mississippi |
Authorized Official Name and Position | Stellanda M Davis (CEO) |
Authorized Official Contact | 6628342566 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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17280 Highway 17 P O Box 479 Lexington MS 39095-6614 Ph: (662) 834-1857 | 17280 Highway 17 Lexington MS 39095-6614 Ph: (662) 834-1857 |
NPI Number | 1437490109 |
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Provider Enumeration Date | 03/06/2013 |
Last Update Date | 03/06/2013 |
Identifier | Type | State | Issuer |
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1437490109 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mallory Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17280 Highway 17, Lexington, MS 39095 Phone: 662-834-1857 Fax: 662-834-1859 | |