| Mississippicare126 | |
|
232 Starlyn Ave New Albany MS 38652-2428 | |
| (662) 486-5122 | |
| (662) 486-5123 |
| Full Name | Mississippicare126 |
|---|---|
| Speciality | Clinic/Center |
| Location | 232 Starlyn Ave, New Albany, Mississippi |
| Authorized Official Name and Position | Steven Collier (CEO) |
| Authorized Official Contact | 8703473300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippicare126 Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | Mississippicare126 232 Starlyn Ave New Albany MS 38652-2428 Ph: (662) 486-5122 |
| NPI Number | 1396439899 |
|---|---|
| Provider Enumeration Date | 06/07/2023 |
| Last Update Date | 02/13/2024 |
| Certification Date | 02/13/2024 |
| Medicare PECOS PAC ID | 2567370620 |
|---|---|
| Medicare Enrollment ID | O20230913001261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396439899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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