Shannon Family Medical Clinic, Llc | |
219 Broad St Shannon MS 38868 | |
(662) 995-2201 | |
(662) 995-2202 |
Full Name | Shannon Family Medical Clinic, Llc |
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Speciality | Clinic/center - Rural Health |
Location | 219 Broad St, Shannon, Mississippi |
Authorized Official Name and Position | Norris N Doss (OWNER) |
Authorized Official Contact | 6629952201 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Shannon Family Medical Clinic, Llc 219 Broad St Shannon MS 38868-9301 Ph: (662) 995-2201 | Shannon Family Medical Clinic, Llc 219 Broad St Shannon MS 38868 Ph: (662) 995-2201 |
NPI Number | 1568633964 |
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Provider Enumeration Date | 03/13/2008 |
Last Update Date | 06/25/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568633964 | NPI | - | NPPES |
05188209 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | R819576 (Mississippi) | Primary |