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345 Highway 15 N Pontotoc MS 38863-1105 | |
(662) 489-7430 | |
(662) 489-7938 |
Full Name | |
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Speciality | Family Medicine |
Location | 345 Highway 15 N, Pontotoc, Mississippi |
Authorized Official Name and Position | Gerald Kimbrough (CBO MANAGER) |
Authorized Official Contact | 6624897430 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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450 E President Ave Tupelo MS 38801-5599 Ph: (662) 377-4685 | 345 Highway 15 N Pontotoc MS 38863-1105 Ph: (662) 489-7430 |
NPI Number | 1548297021 |
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Provider Enumeration Date | 06/28/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1548297021 | NPI | - | NPPES |
09014019 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Redmed, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12 Brookes Xing, Pontotoc, MS 38863 Phone: 662-489-4044 | |
Flavia H West Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 183 S Main St, Pontotoc, MS 38863 Phone: 662-489-5038 Fax: 662-489-7004 | |