| Ummc - Mdpp | |
|
2500 N State St Jackson MS 39216-4500 | |
| (601) 815-2005 | |
| Not Available |
| Full Name | Ummc - Mdpp |
|---|---|
| Speciality | Clinic/Center |
| Location | 2500 N State St, Jackson, Mississippi |
| Authorized Official Name and Position | Jeffrey Grimsley (CFO) |
| Authorized Official Contact | 6018158732 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ummc - Mdpp 504 Clinton Center Dr Cbo-suite 4300 Clinton MS 39056-5677 Ph: (601) 815-2005 | Ummc - Mdpp 2500 N State St Jackson MS 39216-4500 Ph: (601) 815-2005 |
| NPI Number | 1245818301 |
|---|---|
| Provider Enumeration Date | 03/31/2021 |
| Last Update Date | 09/23/2021 |
| Medicare PECOS PAC ID | 1850293036 |
|---|---|
| Medicare Enrollment ID | O20200409002418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245818301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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