Yalobusha Medical Clinic, Llc | |
712 S Main St Water Valley MS 38965-3334 | |
(662) 473-1140 | |
(662) 473-1138 |
Full Name | Yalobusha Medical Clinic, Llc |
---|---|
Speciality | Clinic/Center |
Location | 712 S Main St, Water Valley, Mississippi |
Authorized Official Name and Position | Cinnamon Foster (SOLE MEMBER) |
Authorized Official Contact | 6624731140 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Yalobusha Medical Clinic, Llc 712 S Main St Water Valley MS 38965-3334 Ph: (662) 473-1140 | Yalobusha Medical Clinic, Llc 712 S Main St Water Valley MS 38965-3334 Ph: (662) 473-1140 |
NPI Number | 1295090009 |
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Provider Enumeration Date | 07/08/2012 |
Last Update Date | 04/05/2022 |
Medicare PECOS PAC ID | 1153579586 |
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Medicare Enrollment ID | O20120910000694 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295090009 | NPI | - | NPPES |
1659607232 | Other | NPI, TYPE 1 |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | R872547 (Mississippi) | Primary |
Provider Name | Cinnamon Caryl Foster |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659607232 PECOS PAC ID: 2062660491 Enrollment ID: I20120910000716 |
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