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15 Pumping Station Rd Petal MS 39465-8325 | |
(601) 583-1559 | |
(601) 583-1573 |
Full Name | |
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Speciality | Family Medicine |
Location | 15 Pumping Station Rd, Petal, Mississippi |
Authorized Official Name and Position | Bryan N Batson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6012646000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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415 S 28th Ave Hattiesburg MS 39401-7246 Ph: (601) 579-5463 | 15 Pumping Station Rd Petal MS 39465-8325 Ph: (601) 583-1559 |
NPI Number | 1649356767 |
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Provider Enumeration Date | 10/31/2006 |
Last Update Date | 02/18/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649356767 | NPI | - | NPPES |
09014620 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |