| Cassidy Bayou Medical Clinic | |
|
2372 Us 49-e Sumner MS 38957 | |
| (662) 375-9310 | |
| Not Available |
| Full Name | Cassidy Bayou Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2372 Us 49-e, Sumner, Mississippi |
| Authorized Official Name and Position | Sonja Bush Pennington (PROVIDER/OWNER) |
| Authorized Official Contact | 6623752363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassidy Bayou Medical Clinic Po Box 240 Sumner MS 38957-0240 Ph: (662) 375-9310 | Cassidy Bayou Medical Clinic 2372 Us 49-e Sumner MS 38957 Ph: (662) 375-9310 |
| NPI Number | 1376181990 |
|---|---|
| Provider Enumeration Date | 12/13/2019 |
| Last Update Date | 04/27/2020 |
| Medicare PECOS PAC ID | 4981030319 |
|---|---|
| Medicare Enrollment ID | O20200204000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376181990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sonja N Pennington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386180610 PECOS PAC ID: 7113201906 Enrollment ID: I20170222001577 |
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