| J Russell Barnes Md Pc | |
|
1901 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-0097 | |
| (601) 629-9969 |
| Full Name | J Russell Barnes Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1901 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Russell Barnes (PRES) |
| Authorized Official Contact | 6016360097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Russell Barnes Md Pc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 | J Russell Barnes Md Pc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 |
| NPI Number | 1326289612 |
|---|---|
| Provider Enumeration Date | 03/16/2009 |
| Last Update Date | 06/17/2009 |
| Medicare PECOS PAC ID | 8820062045 |
|---|---|
| Medicare Enrollment ID | O20090820000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326289612 | NPI | - | NPPES |
| 06659829 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 09749 (Mississippi) | Primary |
| Provider Name | John R Barnes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205865680 PECOS PAC ID: 1355302696 Enrollment ID: I20041021000722 |
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