| |
1001 Fountain Dr Forest MS 39074-4038 | |
(601) 469-0234 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 1001 Fountain Dr, Forest, Mississippi |
Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 1001 Fountain Dr Forest MS 39074-4038 Ph: (601) 469-0234 |
NPI Number | 1619640562 |
---|---|
Provider Enumeration Date | 07/27/2021 |
Last Update Date | 10/13/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619640562 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Forest Family Practice Clinic Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Medical Ln, Forest, MS 39074 Phone: 601-469-4861 Fax: 601-469-4828 | |
Independent Healthcare Management, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 516 Airport Rd, Forest, MS 39074 Phone: 601-469-4151 Fax: 601-469-3681 | |