| Pecan Park Elementary School-based | |
|
415 Claiborne Ave Jackson MS 39209-5321 | |
| (601) 364-5142 | |
| Not Available |
| Full Name | Pecan Park Elementary School-based |
|---|---|
| Speciality | Clinic/Center |
| Location | 415 Claiborne Ave, Jackson, Mississippi |
| Authorized Official Name and Position | Jasmin Chapman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6013645142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pecan Park Elementary School-based 3502 W Northside Dr Jackson MS 39213-4454 Ph: () - | Pecan Park Elementary School-based 415 Claiborne Ave Jackson MS 39209-5321 Ph: (601) 364-5142 |
| NPI Number | 1134592777 |
|---|---|
| Provider Enumeration Date | 11/04/2015 |
| Last Update Date | 11/04/2015 |
| Medicare PECOS PAC ID | 4183533235 |
|---|---|
| Medicare Enrollment ID | O20160301000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134592777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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