| Avalon Medical Llc | |
|
1413 W Quitman St Iuka MS 38852-1130 | |
| (662) 424-9550 | |
| Not Available |
| Full Name | Avalon Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1413 W Quitman St, Iuka, Mississippi |
| Authorized Official Name and Position | Tommy Draper (MEMBER) |
| Authorized Official Contact | 6624249550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avalon Medical Llc 1413 W Quitman St Iuka MS 38852-1130 Ph: (662) 424-9550 | Avalon Medical Llc 1413 W Quitman St Iuka MS 38852-1130 Ph: (662) 424-9550 |
| NPI Number | 1710216346 |
|---|---|
| Provider Enumeration Date | 12/10/2009 |
| Last Update Date | 10/18/2011 |
| Medicare PECOS PAC ID | 0345377065 |
|---|---|
| Medicare Enrollment ID | O20100428000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710216346 | NPI | - | NPPES |
| 04352560 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer L Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710959283 PECOS PAC ID: 7113961616 Enrollment ID: I20050615000744 |
| Provider Name | Thomas Draper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144363987 PECOS PAC ID: 0547270001 Enrollment ID: I20060427000422 |
| Provider Name | Elizabeth K Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194956755 PECOS PAC ID: 3870788490 Enrollment ID: I20150713001005 |
| Provider Name | Michelle Draper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457083503 PECOS PAC ID: 2769863356 Enrollment ID: I20220713002832 |
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