| Compassionate Care Clinic. Llc | |
|
218 S Thomas St Tupelo MS 38801-5330 | |
| (662) 269-3870 | |
| Not Available |
| Full Name | Compassionate Care Clinic. Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 218 S Thomas St, Tupelo, Mississippi |
| Authorized Official Name and Position | Cynthia Kohliem (OWNER/OPERATOR) |
| Authorized Official Contact | 6622693870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Compassionate Care Clinic. Llc 218 S Thomas St Tupelo MS 38801-5330 Ph: (662) 269-3870 | Compassionate Care Clinic. Llc 218 S Thomas St Tupelo MS 38801-5330 Ph: (662) 269-3870 |
| NPI Number | 1194276303 |
|---|---|
| Provider Enumeration Date | 10/24/2016 |
| Last Update Date | 07/10/2017 |
| Medicare PECOS PAC ID | 7416226188 |
|---|---|
| Medicare Enrollment ID | O20170712001450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194276303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R875837 (Mississippi) | Primary |
| Provider Name | Cynthia R Kohliem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710315387 PECOS PAC ID: 9830329184 Enrollment ID: I20140306000063 |
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