| Forever Young Mens Health Clinic Pllc | |
|
8837 Lorraine Rd Ste B Gulfport MS 39503-5042 | |
| (228) 669-7293 | |
| Not Available |
| Full Name | Forever Young Mens Health Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8837 Lorraine Rd Ste B, Gulfport, Mississippi |
| Authorized Official Name and Position | Kendrick Mccarty (OWNER) |
| Authorized Official Contact | 2286697293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forever Young Mens Health Clinic Pllc 8837 Lorraine Rd Ste B Gulfport MS 39503-5042 Ph: (228) 669-7293 | Forever Young Mens Health Clinic Pllc 8837 Lorraine Rd Ste B Gulfport MS 39503-5042 Ph: (228) 669-7293 |
| NPI Number | 1114503190 |
|---|---|
| Provider Enumeration Date | 03/22/2021 |
| Last Update Date | 05/11/2022 |
| Medicare PECOS PAC ID | 6002294212 |
|---|---|
| Medicare Enrollment ID | O20220531001741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114503190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Kendrick Mccarty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649621368 PECOS PAC ID: 1153609730 Enrollment ID: I20161102001546 |
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