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154 Mt. Pleasant Road Mt. Pleasant MS 38649 | |
(662) 851-7939 | |
(662) 851-9053 |
Full Name | |
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Speciality | Clinic/Center |
Location | 154 Mt. Pleasant Road, Mt. Pleasant, Mississippi |
Authorized Official Name and Position | Marjorie P. Mckinney (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6628382163 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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12 East Brunswick Ave. P.o. Box 698 Byhalia MS 38611 Ph: (662) 851-7939 | 154 Mt. Pleasant Road Mt. Pleasant MS 38649 Ph: (662) 851-7939 |
NPI Number | 1386792992 |
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Provider Enumeration Date | 01/08/2007 |
Last Update Date | 11/17/2010 |
Medicare PECOS PAC ID | 5294717377 |
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Medicare Enrollment ID | O20101201000541 |
Identifier | Type | State | Issuer |
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1386792992 | NPI | - | NPPES |
9015490 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |