| Sai Sanjeevani Medical Group Llc | |
|
785 Ohio Ave Clarksdale MS 38614-6217 | |
| (662) 351-0702 | |
| Not Available |
| Full Name | Sai Sanjeevani Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 785 Ohio Ave, Clarksdale, Mississippi |
| Authorized Official Name and Position | Gowdhami Mohan (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6623510702 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sai Sanjeevani Medical Group Llc 785 Ohio Ave Clarksdale MS 38614-6217 Ph: () - | Sai Sanjeevani Medical Group Llc 785 Ohio Ave Clarksdale MS 38614-6217 Ph: (662) 351-0702 |
| NPI Number | 1871361121 |
|---|---|
| Provider Enumeration Date | 12/15/2023 |
| Last Update Date | 02/07/2024 |
| Medicare PECOS PAC ID | 5395188858 |
|---|---|
| Medicare Enrollment ID | O20240213000290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871361121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gowdhami Mohan |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1114921806 PECOS PAC ID: 8729973383 Enrollment ID: I20240215001959 |
| Provider Name | Jeanne Mariah Lilly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457120545 PECOS PAC ID: 5395189518 Enrollment ID: I20240215002833 |
| Provider Name | Yamuna Ekambaram |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699740381 PECOS PAC ID: 8628412848 Enrollment ID: I20240215002947 |
| Provider Name | Chitra Mani |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811006901 PECOS PAC ID: 2668536731 Enrollment ID: I20240216001982 |
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