| Midsouth Integrative Medical, Inc | |
|
7651 Tchulahoma Rd Southaven MS 38671-9227 | |
| (662) 349-0980 | |
| (662) 349-0980 |
| Full Name | Midsouth Integrative Medical, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7651 Tchulahoma Rd, Southaven, Mississippi |
| Authorized Official Name and Position | Meagan Chastant-qualls (NURSE PRACTITIONER) |
| Authorized Official Contact | 6623490980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midsouth Integrative Medical, Inc 7651 Tchulahoma Rd Southaven MS 38671-9227 Ph: (662) 349-0980 | Midsouth Integrative Medical, Inc 7651 Tchulahoma Rd Southaven MS 38671-9227 Ph: (662) 349-0980 |
| NPI Number | 1568089993 |
|---|---|
| Provider Enumeration Date | 07/01/2020 |
| Last Update Date | 07/01/2020 |
| Medicare PECOS PAC ID | 6800206806 |
|---|---|
| Medicare Enrollment ID | O20201103000968 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568089993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Marcy C Purnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932431327 PECOS PAC ID: 7012176522 Enrollment ID: I20191014001543 |
| Provider Name | Meagan D Chastant-qualls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215554647 PECOS PAC ID: 9133273451 Enrollment ID: I20201118000750 |
| Provider Name | Molly Luhrs Dunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679141204 PECOS PAC ID: 6901208073 Enrollment ID: I20211014000848 |
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