| Weaver Clinic, Llc | |
|
124 W Commerce St Hernando MS 38632-2240 | |
| (901) 262-0185 | |
| Not Available |
| Full Name | Weaver Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 W Commerce St, Hernando, Mississippi |
| Authorized Official Name and Position | Beverly Pounders Weaver (MEDICAL SUPERVISOR) |
| Authorized Official Contact | 9012620185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Weaver Clinic, Llc 124 W Commerce St Hernando MS 38632-2240 Ph: (901) 262-0185 | Weaver Clinic, Llc 124 W Commerce St Hernando MS 38632-2240 Ph: (901) 262-0185 |
| NPI Number | 1366841066 |
|---|---|
| Provider Enumeration Date | 08/19/2014 |
| Last Update Date | 12/01/2014 |
| Medicare PECOS PAC ID | 9234451774 |
|---|---|
| Medicare Enrollment ID | O20141211001035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366841066 | NPI | - | NPPES |
| 00122952 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | R629189 (Mississippi) | Primary |
| Provider Name | Beverly P Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831140508 PECOS PAC ID: 0648224667 Enrollment ID: I20050311000298 |
| Provider Name | Anita Golden-simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831193440 PECOS PAC ID: 7810933660 Enrollment ID: I20050701000025 |
| Provider Name | Erin Harrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427381151 PECOS PAC ID: 2769517069 Enrollment ID: I20100311000668 |
| Provider Name | Teresa D. Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922310531 PECOS PAC ID: 8729111497 Enrollment ID: I20100802000292 |
| Provider Name | Amanda S Savage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871865717 PECOS PAC ID: 5890955132 Enrollment ID: I20120326000022 |
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