| Pure Therapy, Llc | |
| 
					7955 Huckleberry Ln Summit MS 39666-7086  | |
| (601) 870-4360 | |
| Not Available | 
| Full Name | Pure Therapy, Llc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 7955 Huckleberry Ln, Summit, Mississippi | 
| Authorized Official Name and Position | Micaela Temple Andrus (HALF OWNER) | 
| Authorized Official Contact | 6018704360 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Pure Therapy, Llc 7955 Huckleberry Ln Summit MS 39666-7086 Ph: (601) 870-4360  | Pure Therapy, Llc 7955 Huckleberry Ln Summit MS 39666-7086 Ph: (601) 870-4360  | 
| NPI Number | 1669251369 | 
|---|---|
| Provider Enumeration Date | 09/22/2023 | 
| Last Update Date | 09/27/2023 | 
| Medicare PECOS PAC ID | 9032565544 | 
|---|---|
| Medicare Enrollment ID | O20231019001364 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1669251369 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary | 
| Provider Name | Micaela Temple Andrus | 
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist | 
| Provider Identifiers | NPI Number: 1639958333 PECOS PAC ID: 0941656458 Enrollment ID: I20231024002425  | 
Pinnacle Medical Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7900 Highway 570, Summit, MS 39666 Phone: 601-684-7771 Fax: 601-684-1616  | |
Southwest Mississippi Regional Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 802 W Railroad Ave, Summit, MS 39666 Phone: 601-250-4420 Fax: 601-250-4421  | |
Jennifer D Gholson Md, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 804 Robb St, Summit, MS 39666 Phone: 601-276-7665 Fax: 601-276-7655  | |
Southwest Mississippi Regional Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 802 W Railroad Ave, Summit, MS 39666 Phone: 601-250-4420 Fax: 601-250-4421  |