| Kdmc Pediatric Adolescent Clinic | |
|
509 Brookman Dr. Brookhaven MS 39601-2326 | |
| (601) 823-5204 | |
| Not Available |
| Full Name | Kdmc Pediatric Adolescent Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 509 Brookman Dr., Brookhaven, Mississippi |
| Authorized Official Name and Position | Scott Christensen (CEO) |
| Authorized Official Contact | 6018359488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kdmc Pediatric Adolescent Clinic 427 Highway 51 N Brookhaven MS 39601-2350 Ph: (601) 835-9275 | Kdmc Pediatric Adolescent Clinic 509 Brookman Dr. Brookhaven MS 39601-2326 Ph: (601) 823-5204 |
| NPI Number | 1275307902 |
|---|---|
| Provider Enumeration Date | 11/13/2023 |
| Last Update Date | 11/13/2023 |
| Certification Date | 11/13/2023 |
| Medicare PECOS PAC ID | 3072575539 |
|---|---|
| Medicare Enrollment ID | O20240108005144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275307902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
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