| Desoto Family Medical Center | |
|
75 Physician Lane Southaven MS 38671 | |
| (662) 393-7722 | |
| (662) 393-7756 |
| Full Name | Desoto Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 75 Physician Lane, Southaven, Mississippi |
| Authorized Official Name and Position | Angel Burnette (FINANCIAL SERVICES MANAGER) |
| Authorized Official Contact | 6622806233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Family Medical Center 75 Physician Lane Southaven MS 38671 Ph: (662) 393-7722 | Desoto Family Medical Center 75 Physician Lane Southaven MS 38671 Ph: (662) 393-7722 |
| NPI Number | 1528150398 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 10/10/2008 |
| Medicare PECOS PAC ID | 2567470412 |
|---|---|
| Medicare Enrollment ID | O20060404000200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528150398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Troy Dale Morris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891792883 PECOS PAC ID: 1557379401 Enrollment ID: I20091228000162 |
| Provider Name | Antronette L Mckenzie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336146315 PECOS PAC ID: 8022066323 Enrollment ID: I20100125000041 |
| Provider Name | Amy E Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003161373 PECOS PAC ID: 2365664604 Enrollment ID: I20141120002206 |
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