| Family Medical Clinic Of Crystal Springs Pllc | |
|
104 W Railroad Ave S Crystal Springs MS 39059-2111 | |
| (601) 892-3063 | |
| (601) 892-3570 |
| Full Name | Family Medical Clinic Of Crystal Springs Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 104 W Railroad Ave S, Crystal Springs, Mississippi |
| Authorized Official Name and Position | James W Ervin (PRESIDENT) |
| Authorized Official Contact | 6018923063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Clinic Of Crystal Springs Pllc 104 W Railroad Ave S Crystal Springs MS 39059-2111 Ph: (601) 892-3063 | Family Medical Clinic Of Crystal Springs Pllc 104 W Railroad Ave S Crystal Springs MS 39059-2111 Ph: (601) 892-3063 |
| NPI Number | 1205915998 |
|---|---|
| Provider Enumeration Date | 11/03/2006 |
| Last Update Date | 09/30/2011 |
| Medicare PECOS PAC ID | 6002894706 |
|---|---|
| Medicare Enrollment ID | O20040709000565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205915998 | NPI | - | NPPES |
| 06726832 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James W Ervin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619903580 PECOS PAC ID: 9638157332 Enrollment ID: I20040712001528 |
| Provider Name | Jennifer Sojourner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679881312 PECOS PAC ID: 9436338134 Enrollment ID: I20110127000371 |
| Provider Name | Jenna L Gaddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114470143 PECOS PAC ID: 0840576039 Enrollment ID: I20170425001328 |
| Provider Name | Mary Kamryn Brewer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255943932 PECOS PAC ID: 4284041039 Enrollment ID: I20210324000630 |
Robert A. Gannaway, M.d., Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 408 E Railroad Ave, Suite B, Crystal Springs, MS 39059 Phone: 601-892-7860 Fax: 601-892-7861 | |
Copiah County Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 123 Bo Bo Dr, Crystal Springs, MS 39059 Phone: 601-892-2225 Fax: 601-892-1456 |