| Mississippicare129 | |
|
2173 S Lamar Blvd Oxford MS 38655-5223 | |
| (662) 234-6553 | |
| (662) 234-6555 |
| Full Name | Mississippicare129 |
|---|---|
| Speciality | Clinic/Center |
| Location | 2173 S Lamar Blvd, Oxford, Mississippi |
| Authorized Official Name and Position | Steven Collier (CEO) |
| Authorized Official Contact | 8703473204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippicare129 Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | Mississippicare129 2173 S Lamar Blvd Oxford MS 38655-5223 Ph: (662) 234-6553 |
| NPI Number | 1124661855 |
|---|---|
| Provider Enumeration Date | 10/25/2019 |
| Last Update Date | 10/09/2020 |
| Certification Date | 10/09/2020 |
| Medicare PECOS PAC ID | 2567370620 |
|---|---|
| Medicare Enrollment ID | O20200302000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124661855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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