| Ware Family Practice Llc | |
|
972 Columbia Ave Prentiss MS 39474-5405 | |
| (601) 792-5343 | |
| Not Available |
| Full Name | Ware Family Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 972 Columbia Ave, Prentiss, Mississippi |
| Authorized Official Name and Position | Ashley Kirby Ware (OWNER) |
| Authorized Official Contact | 6015435859 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ware Family Practice Llc Po Box 2275 Prentiss MS 39474-2275 Ph: (601) 792-5343 | Ware Family Practice Llc 972 Columbia Ave Prentiss MS 39474-5405 Ph: (601) 792-5343 |
| NPI Number | 1730829060 |
|---|---|
| Provider Enumeration Date | 04/01/2022 |
| Last Update Date | 08/08/2023 |
| Medicare PECOS PAC ID | 4486020633 |
|---|---|
| Medicare Enrollment ID | O20221013001365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730829060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ashley K Kirby Ware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912258450 PECOS PAC ID: 8426295148 Enrollment ID: I20130516000162 |
| Provider Name | Brittney Evette Bracey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407398845 PECOS PAC ID: 3072895051 Enrollment ID: I20170127000454 |
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