| Primary And Behavioral Healthcare Services, Pa | |
|
717 E. Fortification St. Jackson MS 39202-2402 | |
| (769) 572-4009 | |
| (769) 572-4021 |
| Full Name | Primary And Behavioral Healthcare Services, Pa |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 717 E. Fortification St., Jackson, Mississippi |
| Authorized Official Name and Position | Shameca L Hudson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7695724009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary And Behavioral Healthcare Services, Pa 717 E. Fortification St. Jackson MS 39202-2402 Ph: (769) 572-4009 | Primary And Behavioral Healthcare Services, Pa 717 E. Fortification St. Jackson MS 39202-2402 Ph: (769) 572-4009 |
| NPI Number | 1710545488 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 10/04/2024 |
| Medicare PECOS PAC ID | 4486984796 |
|---|---|
| Medicare Enrollment ID | O20191001000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710545488 | NPI | - | NPPES |
| 005486078 | Medicaid | MS | |
| 1679135982 | Medicaid | MS | |
| 1710545488 | Medicaid | MS | |
| 00000000 | Medicaid | MS | |
| 858885 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Shameca Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619362977 PECOS PAC ID: 7416265665 Enrollment ID: I20151007002887 |
Ben W. Seale, M.d., Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 971 Lakeland Dr, Suite 450, Jackson, MS 39216 Phone: 601-948-5158 Fax: 601-949-6058 | |
Central Mississippi Health Services, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3450 Highway 80 W Ste 71, Jackson, MS 39209 Phone: 601-321-2400 | |
Hni Medical Services Of Mississippi, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 969 Lakeland Dr, Jackson, MS 39216 Phone: 601-200-2000 | |
Medical Care Associates Mobile Unit Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3855 Azalea Dr, Jackson, MS 39206 Phone: 601-366-9447 | |
The Wound Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1850 Chadwick Dr, Jackson, MS 39204 Phone: 601-376-2561 Fax: 601-376-2570 | |
Quad Intermed Company Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5005 Old Canton Rd, Jackson, MS 39211 Phone: 601-957-3333 | |
Vanessa L. Sandifer, M.d., Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 971 Lakeland Drive, Suite 450, Jackson, MS 39216 Phone: 601-948-5158 Fax: 601-949-6058 |