| Premise Health Of Mississippi Medical Pc | |
|
1021 Casino Center Dr Robinsonville MS 38664-9708 | |
| (662) 357-3264 | |
| (662) 357-6092 |
| Full Name | Premise Health Of Mississippi Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1021 Casino Center Dr, Robinsonville, Mississippi |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of Mississippi Medical Pc 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Premise Health Of Mississippi Medical Pc 1021 Casino Center Dr Robinsonville MS 38664-9708 Ph: (662) 357-3264 |
| NPI Number | 1861623852 |
|---|---|
| Provider Enumeration Date | 08/07/2009 |
| Last Update Date | 10/13/2022 |
| Medicare PECOS PAC ID | 1052859402 |
|---|---|
| Medicare Enrollment ID | O20240815003196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861623852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kavita B Kansagra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639321326 PECOS PAC ID: 4385708155 Enrollment ID: I20110315000878 |
| Provider Name | Melanie Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033258926 PECOS PAC ID: 1951335058 Enrollment ID: I20240815003469 |