| Tupelo Medical Group, Llc | |
|
1265 Cliff Gookin Boulevard Tupelo MS 38801-6749 | |
| (662) 840-2131 | |
| (662) 840-2522 |
| Full Name | Tupelo Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1265 Cliff Gookin Boulevard, Tupelo, Mississippi |
| Authorized Official Name and Position | Julian D. Loden (VICE PRESIDENT) |
| Authorized Official Contact | 6624072528 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tupelo Medical Group, Llc 1265 Cliff Gookin Boulevard Tupelo MS 38801-6749 Ph: (662) 407-2528 | Tupelo Medical Group, Llc 1265 Cliff Gookin Boulevard Tupelo MS 38801-6749 Ph: (662) 840-2131 |
| NPI Number | 1396783916 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 12/12/2011 |
| Medicare PECOS PAC ID | 2769482439 |
|---|---|
| Medicare Enrollment ID | O20070102000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396783916 | NPI | - | NPPES |
| 09015601 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Julian Loden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932155538 PECOS PAC ID: 9931109600 Enrollment ID: I20100827000637 |
| Provider Name | Mary Ellis Pace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912946450 PECOS PAC ID: 2668472333 Enrollment ID: I20100902000044 |
| Provider Name | Donald Ricky Parker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801835343 PECOS PAC ID: 4385644053 Enrollment ID: I20100909000003 |
| Provider Name | Pami Jo Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477592632 PECOS PAC ID: 6103826870 Enrollment ID: I20100915000729 |
| Provider Name | Brandie W Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952695496 PECOS PAC ID: 0042489619 Enrollment ID: I20110816000701 |
| Provider Name | Carmen Renae Raines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104241686 PECOS PAC ID: 3577783273 Enrollment ID: I20141001000179 |
| Provider Name | Benjamin R Gilliland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073967238 PECOS PAC ID: 5597011049 Enrollment ID: I20180713000616 |
| Provider Name | Meagan Z Hillhouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013484864 PECOS PAC ID: 7113269796 Enrollment ID: I20190501000262 |
| Provider Name | Jessica Braddock Childs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467095869 PECOS PAC ID: 2567839103 Enrollment ID: I20221110001174 |
South Madison Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1040a S. Madison St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
Nmmc Ekg Interpretations Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 830 S Gloster St, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2755 | |
North Mississippi Neurosurgical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801 Phone: 662-377-5700 Fax: 662-377-5720 | |
Pontotoc Health Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 Fax: 662-377-2057 | |
Grant Family Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Varsity Dr, Tupelo, MS 38801 Phone: 484-252-6707 | |
North Mississippi Medical Clinics Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 450 E President Ave, Tupelo, MS 38801 Phone: 662-377-4685 | |
Advanced Wound Center Professionals Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 S Gloster St, 1st Floor East Tower, Tupelo, MS 38801 Phone: 662-377-2395 Fax: 662-377-2397 |