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7920 U S Highway 11 Lumberton MS 39455-2411 | |
(601) 796-2451 | |
(601) 796-9437 |
Full Name | |
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Speciality | Clinic/Center |
Location | 7920 U S Highway 11, Lumberton, Mississippi |
Authorized Official Name and Position | Kaye Ray (CEO) |
Authorized Official Contact | 6015458700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | 7920 U S Highway 11 Lumberton MS 39455-2411 Ph: (601) 796-2451 |
NPI Number | 1356915516 |
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Provider Enumeration Date | 05/13/2021 |
Last Update Date | 09/06/2022 |
Medicare PECOS PAC ID | 2466342605 |
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Medicare Enrollment ID | O20230113001315 |
Identifier | Type | State | Issuer |
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1356915516 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Lumberton Public School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 E 10th Ave, Lumberton, MS 39455 Phone: 601-796-2441 |