| Pascagoula Family Practice Clinic Pllc | |
|
Ste 202 4211 Hospital Street Pascagoula MS 39581-5310 | |
| (228) 762-3466 | |
| (228) 762-6349 |
| Full Name | Pascagoula Family Practice Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | Ste 202, Pascagoula, Mississippi |
| Authorized Official Name and Position | Gary Henry Groff (PARTNER) |
| Authorized Official Contact | 2287623466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pascagoula Family Practice Clinic Pllc Ste 202 4211 Hospital Street Pascagoula MS 39581-5310 Ph: (228) 762-3466 | Pascagoula Family Practice Clinic Pllc Ste 202 4211 Hospital Street Pascagoula MS 39581-5310 Ph: (228) 762-3466 |
| NPI Number | 1134155732 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 01/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134155732 | NPI | - | NPPES |
| 09015379 | Medicaid | MS | |
| CH5730 | Other | MS | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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