Full Name | |
---|---|
Speciality | Clinic/center |
Location | 780 Main Street, Weir, Mississippi |
Authorized Official Name and Position | Thomas Higgins (PRESIDENT OF THE BOARD) |
Authorized Official Contact | 6625479407 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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780 Main Street Weir MS 39772-0000 Ph: (662) 547-9407 | 780 Main Street Weir MS 39772-0000 Ph: (662) 547-9407 |
NPI Number | 1063711349 |
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Provider Enumeration Date | 03/25/2011 |
Last Update Date | 03/25/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063711349 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |