Medical Clinic Llc | |
713 Watts St Monticello MS 39654-9313 | |
(601) 587-7795 | |
Not Available |
Full Name | Medical Clinic Llc |
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Speciality | Family Medicine |
Location | 713 Watts St, Monticello, Mississippi |
Authorized Official Name and Position | Thomas Pace (MANAGING PARTNER) |
Authorized Official Contact | 8649151949 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Medical Clinic Llc Po Box 518 Monticello MS 39654-0518 Ph: (864) 915-1949 | Medical Clinic Llc 713 Watts St Monticello MS 39654-9313 Ph: (601) 587-7795 |
NPI Number | 1598449167 |
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Provider Enumeration Date | 06/13/2023 |
Last Update Date | 06/13/2023 |
Medicare PECOS PAC ID | 4880053271 |
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Medicare Enrollment ID | O20230703001304 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598449167 | NPI | - | NPPES |
1780849109 | Other | MS | NURSE PRACTITIONER |
1780849109 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Kiley Mclendon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780849109 PECOS PAC ID: 7113095407 Enrollment ID: I20081014000670 |
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James W Stephens Md Family Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 Courthouse Sq, Monticello, MS 39654 Phone: 601-587-0209 Fax: 601-587-0436 | |
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