| Mooneyham Properties | |
|
1127 Old Fannin Rd C Brandon MS 39047-9265 | |
| (601) 214-4420 | |
| Not Available |
| Full Name | Mooneyham Properties |
|---|---|
| Speciality | Clinic/Center |
| Location | 1127 Old Fannin Rd, Brandon, Mississippi |
| Authorized Official Name and Position | Jennifer Wedgeworth Mooneyham (PROVIDER/OWNER) |
| Authorized Official Contact | 6012144420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mooneyham Properties 1127 Old Fannin Rd C Brandon MS 39047-9265 Ph: (601) 214-4420 | Mooneyham Properties 1127 Old Fannin Rd C Brandon MS 39047-9265 Ph: (601) 214-4420 |
| NPI Number | 1184913014 |
|---|---|
| Provider Enumeration Date | 03/31/2011 |
| Last Update Date | 03/31/2011 |
| Medicare PECOS PAC ID | 7517141229 |
|---|---|
| Medicare Enrollment ID | O20110405000062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184913014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MS845026 (Mississippi) | Primary |
| Provider Name | Jennifer W Mooneyham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134349913 PECOS PAC ID: 5799969408 Enrollment ID: I20110405000075 |
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