| Mississippicare 113 | |
|
353 Highway 15 N Pontotoc MS 38863-1103 | |
| (662) 490-1985 | |
| (662) 490-1989 |
| Full Name | Mississippicare 113 |
|---|---|
| Speciality | Clinic/Center |
| Location | 353 Highway 15 N, Pontotoc, Mississippi |
| Authorized Official Name and Position | Steven Collier (CEO) |
| Authorized Official Contact | 8703472534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippicare 113 Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | Mississippicare 113 353 Highway 15 N Pontotoc MS 38863-1103 Ph: (662) 490-1985 |
| NPI Number | 1699292797 |
|---|---|
| Provider Enumeration Date | 08/29/2017 |
| Last Update Date | 01/20/2021 |
| Medicare PECOS PAC ID | 2567370620 |
|---|---|
| Medicare Enrollment ID | O20171010003520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699292797 | NPI | - | NPPES |
| 09322257 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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