| |
100 Highway 535 Seminary MS 39479-9217 | |
(601) 722-3208 | |
(601) 722-3304 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 100 Highway 535, Seminary, Mississippi |
Authorized Official Name and Position | Kaye Ray (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6015458700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | 100 Highway 535 Seminary MS 39479-9217 Ph: (601) 722-3208 |
NPI Number | 1851368260 |
---|---|
Provider Enumeration Date | 03/03/2006 |
Last Update Date | 09/06/2022 |
Medicare PECOS PAC ID | 2466342605 |
---|---|
Medicare Enrollment ID | O20100113000855 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851368260 | NPI | - | NPPES |
09010042 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |