| Booneville Community Health Center | |
|
208 N 1st St Booneville MS 38829-2718 | |
| (662) 728-3313 | |
| (662) 728-5623 |
| Full Name | Booneville Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 208 N 1st St, Booneville, Mississippi |
| Authorized Official Name and Position | James D Nunnally (CEO) |
| Authorized Official Contact | 6622248951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Booneville Community Health Center 15921 Boundary Dr Po Box 92 Ashland MS 38603-7740 Ph: (662) 224-8951 | Booneville Community Health Center 208 N 1st St Booneville MS 38829-2718 Ph: (662) 728-3313 |
| NPI Number | 1083009450 |
|---|---|
| Provider Enumeration Date | 04/02/2015 |
| Last Update Date | 04/10/2015 |
| Medicare PECOS PAC ID | 3274513528 |
|---|---|
| Medicare Enrollment ID | O20140925001515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083009450 | NPI | - | NPPES |
| 09011971 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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