| 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  |