Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 518 West Dr, Okolona, Mississippi |
Authorized Official Name and Position | Robert Quentin Whitwell (CEO) |
Authorized Official Contact | 6627019346 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 432 Houston MS 38851-0432 Ph: (662) 447-6170 | 518 West Dr Okolona MS 38860-1624 Ph: (662) 447-6170 |
NPI Number | 1720845100 |
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Provider Enumeration Date | 03/04/2024 |
Last Update Date | 07/26/2024 |
Medicare PECOS PAC ID | 0143662429 |
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Medicare Enrollment ID | O20240604002663 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720845100 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Chickasaw Fmc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 518 West Dr, Okolona, MS 38860 Phone: 662-447-2255 | |