| Complete Care Rural Health Clinic | |
|
1911 Mission 66 Ste B Vicksburg MS 39180-3762 | |
| (601) 665-4162 | |
| (855) 830-3484 |
| Full Name | Complete Care Rural Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1911 Mission 66 Ste B, Vicksburg, Mississippi |
| Authorized Official Name and Position | Christopher J Watkins (MEMBER) |
| Authorized Official Contact | 6019519863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Complete Care Rural Health Clinic 215 Katherine Drive Suite A Flowood MS 39232-9588 Ph: (601) 665-4162 | Complete Care Rural Health Clinic 1911 Mission 66 Ste B Vicksburg MS 39180-3762 Ph: (601) 665-4162 |
| NPI Number | 1669835310 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 09/06/2023 |
| Certification Date | 09/06/2023 |
| Medicare PECOS PAC ID | 0749572915 |
|---|---|
| Medicare Enrollment ID | O20160708000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669835310 | NPI | - | NPPES |
| 007877558 | Medicaid | MS | |
| 001583061 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Mississippi) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Gary A Roberson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629133400 PECOS PAC ID: 1456252618 Enrollment ID: I20040120000367 |
| Provider Name | Stella S Culliver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821365511 PECOS PAC ID: 1658547815 Enrollment ID: I20120110000574 |
| Provider Name | Laura King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801179791 PECOS PAC ID: 8325215924 Enrollment ID: I20120123000635 |
| Provider Name | Toni L. Ladner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922374057 PECOS PAC ID: 6507027588 Enrollment ID: I20120418000785 |
| Provider Name | Mazhar Salim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013075449 PECOS PAC ID: 4789775842 Enrollment ID: I20160413001187 |
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