| |
1440 Jefferson St Suite B Laurel MS 39440-4243 | |
(601) 649-6213 | |
(601) 649-6217 |
Full Name | |
---|---|
Speciality | General Practice |
Location | 1440 Jefferson St, Laurel, Mississippi |
Authorized Official Name and Position | James T Canizaro (CFO/VP OF FINANCE) |
Authorized Official Contact | 6013996139 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 247 Laurel MS 39441-0247 Ph: (601) 425-7550 | 1440 Jefferson St Suite B Laurel MS 39440-4243 Ph: (601) 649-6213 |
NPI Number | 1619346863 |
---|---|
Provider Enumeration Date | 09/17/2015 |
Last Update Date | 01/19/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619346863 | NPI | - | NPPES |
01880574 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
293D00000X | Physiological Laboratory | (* (Not Available)) | Secondary |
Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 S 11th Ave, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-428-6561 | |
Jefferson Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |