| Prolific Health & Wellness Pa | |
|
2675 River Ridge Dr Jackson MS 39216-5012 | |
| (769) 257-0586 | |
| Not Available |
| Full Name | Prolific Health & Wellness Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2675 River Ridge Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Kimberly Mccullough Smash (FOUNDER) |
| Authorized Official Contact | 7692570586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prolific Health & Wellness Pa 605 Chickasaw Dr N Flowood MS 39232-8680 Ph: () - | Prolific Health & Wellness Pa 2675 River Ridge Dr Jackson MS 39216-5012 Ph: (769) 257-0586 |
| NPI Number | 1962913541 |
|---|---|
| Provider Enumeration Date | 10/23/2017 |
| Last Update Date | 01/03/2018 |
| Medicare PECOS PAC ID | 3971862160 |
|---|---|
| Medicare Enrollment ID | O20180116001079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962913541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Ini-abasi J Olutade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902907223 PECOS PAC ID: 4789762725 Enrollment ID: I20080416000509 |
| Provider Name | Kimberly M Smash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881892552 PECOS PAC ID: 6406036813 Enrollment ID: I20110202000094 |
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 | |
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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 | |
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