| |
1002 E Madison St Ste B Houston MS 38851-2428 | |
(662) 456-2800 | |
(662) 456-1715 |
Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 1002 E Madison St Ste B, Houston, Mississippi |
Authorized Official Name and Position | Sheila Brockman (CEO) |
Authorized Official Contact | 6624563700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 432 Houston MS 38851-0432 Ph: (662) 456-2800 | 1002 E Madison St Ste B Houston MS 38851-2428 Ph: (662) 456-2800 |
NPI Number | 1194833400 |
---|---|
Provider Enumeration Date | 08/27/2006 |
Last Update Date | 01/18/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194833400 | NPI | - | NPPES |
258518 | Other | MS | TRISPAN |
C02335 | Other | MS | MEDICARE PART B GROUP |
07978511 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Digestive Disease Center Of Houston Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1002 E Madison St, Houston, MS 38851 Phone: 662-456-9203 Fax: 662-456-9206 |