| Caretime Medical Clinic, Llc | |
|
1506 Highway 278 E Ste A Amory MS 38821-5906 | |
| (662) 597-2019 | |
| Not Available |
| Full Name | Caretime Medical Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1506 Highway 278 E Ste A, Amory, Mississippi |
| Authorized Official Name and Position | Shannon Leianne Ballard (OWNER) |
| Authorized Official Contact | 6625972019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caretime Medical Clinic, Llc 1506 Highway 278 E Ste A Amory MS 38821-5906 Ph: (662) 597-2019 | Caretime Medical Clinic, Llc 1506 Highway 278 E Ste A Amory MS 38821-5906 Ph: (662) 597-2019 |
| NPI Number | 1700247855 |
|---|---|
| Provider Enumeration Date | 03/17/2016 |
| Last Update Date | 04/28/2016 |
| Medicare PECOS PAC ID | 4587953096 |
|---|---|
| Medicare Enrollment ID | O20160523000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700247855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Clinton L Washington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437163763 PECOS PAC ID: 3173530698 Enrollment ID: I20060308000518 |
| Provider Name | Laura L Washington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093721151 PECOS PAC ID: 1254348774 Enrollment ID: I20060308000537 |
| Provider Name | Shannon L Ballard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275836991 PECOS PAC ID: 3779750948 Enrollment ID: I20120111000978 |
| Provider Name | Elaina Ponder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235783127 PECOS PAC ID: 2062839814 Enrollment ID: I20200825003861 |
| Provider Name | Carl Andrew Ballard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386243574 PECOS PAC ID: 3577971019 Enrollment ID: I20210421001587 |
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