Senior Care Clinic Llc | |
109 School Street Ext Newton MS 39345-2272 | |
(601) 527-5679 | |
Not Available |
Full Name | Senior Care Clinic Llc |
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Speciality | Clinic/Center |
Location | 109 School Street Ext, Newton, Mississippi |
Authorized Official Name and Position | Timothy Thomas (OWNER) |
Authorized Official Contact | 6015275679 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Senior Care Clinic Llc Po Box 941 Decatur MS 39327-0941 Ph: (601) 527-5679 | Senior Care Clinic Llc 109 School Street Ext Newton MS 39345-2272 Ph: (601) 527-5679 |
NPI Number | 1093443103 |
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Provider Enumeration Date | 08/08/2022 |
Last Update Date | 08/08/2022 |
Medicare PECOS PAC ID | 5193100402 |
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Medicare Enrollment ID | O20220921003991 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093443103 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Mary T Smith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144382672 PECOS PAC ID: 9739361023 Enrollment ID: I20110308000458 |
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