| Bmc Leake Carthage Primary Care | |
|
1100 Hwy 16 East Carthage MS 39051-3809 | |
| (601) 267-1470 | |
| (601) 267-1469 |
| Full Name | Bmc Leake Carthage Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Hwy 16 East, Carthage, Mississippi |
| Authorized Official Name and Position | Gregory M Duckett (SR VP/CLO) |
| Authorized Official Contact | 9012275233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bmc Leake Carthage Primary Care 350 N Humphreys Blvd Memphis TN 38120-2177 Ph: (601) 267-1470 | Bmc Leake Carthage Primary Care 1100 Hwy 16 East Carthage MS 39051-3809 Ph: (601) 267-1470 |
| NPI Number | 1194861260 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 04/29/2022 |
| Certification Date | 04/29/2022 |
| Medicare PECOS PAC ID | 7214102961 |
|---|---|
| Medicare Enrollment ID | O20111208000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194861260 | NPI | - | NPPES |
| 09016232 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 11187 (Mississippi) | Primary |
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