| Durant Primary Care Clinic | |
|
638 Northwest Ave Durant MS 39063-3337 | |
| (662) 653-1002 | |
| (662) 653-1038 |
| Full Name | Durant Primary Care Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 638 Northwest Ave, Durant, Mississippi |
| Authorized Official Name and Position | Elias Abboud (OWNER) |
| Authorized Official Contact | 6626531002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Durant Primary Care Clinic 638 Northwest Ave Durant MS 39063-3337 Ph: (662) 653-1002 | Durant Primary Care Clinic 638 Northwest Ave Durant MS 39063-3337 Ph: (662) 653-1002 |
| NPI Number | 1124100813 |
|---|---|
| Provider Enumeration Date | 10/20/2006 |
| Last Update Date | 09/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124100813 | NPI | - | NPPES |
| 01824892 | Medicaid | MS | |
| 09807861 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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