| |
180 Park Plaza Dr New Albany MS 38652-3127 | |
(662) 222-2219 | |
(662) 510-0216 |
Full Name | |
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Speciality | Clinic/Center |
Location | 180 Park Plaza Dr, New Albany, Mississippi |
Authorized Official Name and Position | Samantha Logan (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 6622222273 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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874 Barnes Crossing Rd Tupelo MS 38804-0909 Ph: (662) 841-0002 | 180 Park Plaza Dr New Albany MS 38652-3127 Ph: (662) 222-2219 |
NPI Number | 1154916872 |
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Provider Enumeration Date | 03/04/2021 |
Last Update Date | 11/11/2024 |
Medicare PECOS PAC ID | 6002258720 |
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Medicare Enrollment ID | O20240528001133 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154916872 | NPI | - | NPPES |
Provider Name | Arland Dale Jones |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578557906 PECOS PAC ID: 0143242586 Enrollment ID: I20051228000477 |
Provider Name | Leaura B Galbraith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538459078 PECOS PAC ID: 9133398761 Enrollment ID: I20110816000274 |
Provider Name | Nicholas Elliott |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942819974 PECOS PAC ID: 0042627051 Enrollment ID: I20210318000514 |
Provider Name | Kane Andrew Mccool |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124624895 PECOS PAC ID: 3577972660 Enrollment ID: I20210430001131 |
Provider Name | Amanda Allred |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275145781 PECOS PAC ID: 8820494842 Enrollment ID: I20210831000357 |
Provider Name | Helen Paige Long |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487261954 PECOS PAC ID: 2961894613 Enrollment ID: I20220110001606 |
Provider Name | Stormi Valentine |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811609894 PECOS PAC ID: 2668844655 Enrollment ID: I20230221003025 |
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