| Southaven Internal Medicine, P.c. | |
|
7680 Airways Blvd Southaven MS 38671-5304 | |
| (662) 349-1999 | |
| (662) 349-9734 |
| Full Name | Southaven Internal Medicine, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 7680 Airways Blvd, Southaven, Mississippi |
| Authorized Official Name and Position | Kandis P Sledge (OFFICE MANAGER) |
| Authorized Official Contact | 6623491999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southaven Internal Medicine, P.c. 7680 Airways Blvd Southaven MS 38671-5304 Ph: (662) 349-1999 | Southaven Internal Medicine, P.c. 7680 Airways Blvd Southaven MS 38671-5304 Ph: (662) 349-1999 |
| NPI Number | 1932259355 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 06/17/2010 |
| Medicare PECOS PAC ID | 7416858683 |
|---|---|
| Medicare Enrollment ID | O20110126000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932259355 | NPI | - | NPPES |
| 09015446 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Mississippi) | Primary |
| Provider Name | Mary S Missak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962507061 PECOS PAC ID: 7416015904 Enrollment ID: I20081028000478 |
| Provider Name | Magdi Wassef |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275638363 PECOS PAC ID: 9032010210 Enrollment ID: I20081028000490 |
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