| Sage Health Mississippi Llc | |
|
117 Hardy Court Shopping Ctr Gulfport MS 39507-2528 | |
| (228) 678-2459 | |
| Not Available |
| Full Name | Sage Health Mississippi Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 117 Hardy Court Shopping Ctr, Gulfport, Mississippi |
| Authorized Official Name and Position | John Haskell (CEO) |
| Authorized Official Contact | 6159889771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sage Health Mississippi Llc 501 Union St Suite 545 Pmb 82739 Nashville TN 37219-1876 Ph: () - | Sage Health Mississippi Llc 117 Hardy Court Shopping Ctr Gulfport MS 39507-2528 Ph: (228) 678-2459 |
| NPI Number | 1861103400 |
|---|---|
| Provider Enumeration Date | 12/05/2022 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 2264876358 |
|---|---|
| Medicare Enrollment ID | O20240216001194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861103400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | David F Roberts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932118965 PECOS PAC ID: 4688666209 Enrollment ID: I20040401001312 |
| Provider Name | Tiffany J Mensi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770854481 PECOS PAC ID: 8921266198 Enrollment ID: I20141212002039 |
| Provider Name | Syeda Shaista Rumman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770705204 PECOS PAC ID: 7113043928 Enrollment ID: I20161228000111 |
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