| Kdmc Physician Clinics Llc | |
|
950 Brookway Blvd Brookhaven MS 39601-2644 | |
| (601) 823-5103 | |
| (601) 823-3514 |
| Full Name | Kdmc Physician Clinics Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 950 Brookway Blvd, 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 Physician Clinics Llc 427 Highway 51 N Brookhaven MS 39601-2350 Ph: (601) 833-6011 | Kdmc Physician Clinics Llc 950 Brookway Blvd Brookhaven MS 39601-2644 Ph: (601) 823-5103 |
| NPI Number | 1861739161 |
|---|---|
| Provider Enumeration Date | 01/08/2013 |
| Last Update Date | 03/27/2023 |
| Medicare PECOS PAC ID | 7012154495 |
|---|---|
| Medicare Enrollment ID | O20130501000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861739161 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Charles M Holland |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285657916 PECOS PAC ID: 8527025956 Enrollment ID: I20041216000688 |
| Provider Name | David S Braden |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689697336 PECOS PAC ID: 8426015876 Enrollment ID: I20050103000207 |
| Provider Name | Eugene A Simmons |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1992766943 PECOS PAC ID: 3476511890 Enrollment ID: I20050103000498 |
| Provider Name | Jennifer L Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730371964 PECOS PAC ID: 3274575394 Enrollment ID: I20050531000507 |
| Provider Name | Tina R Reed-hearn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811004914 PECOS PAC ID: 7214961200 Enrollment ID: I20050920000363 |
| Provider Name | Dena W Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477663318 PECOS PAC ID: 5597772939 Enrollment ID: I20060309000665 |
| Provider Name | John E Turba |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1366575763 PECOS PAC ID: 6002913860 Enrollment ID: I20070514000295 |
| Provider Name | Catherine W Knott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386658763 PECOS PAC ID: 8527166602 Enrollment ID: I20070613000628 |
| Provider Name | John D Richardson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144230038 PECOS PAC ID: 2668547993 Enrollment ID: I20080820000487 |
| Provider Name | Earl D Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447412275 PECOS PAC ID: 5092883447 Enrollment ID: I20081013000065 |
| Provider Name | Craig D Berteau |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518130392 PECOS PAC ID: 9931265311 Enrollment ID: I20090310000413 |
| Provider Name | Karla A Gerald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518299213 PECOS PAC ID: 6608901046 Enrollment ID: I20100324000236 |
| Provider Name | Ramiro A. Montalvo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225147135 PECOS PAC ID: 5991848491 Enrollment ID: I20100826000599 |
| Provider Name | Timothy R Shann |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477518793 PECOS PAC ID: 2567646227 Enrollment ID: I20110405000750 |
| Provider Name | Joshua W Iles |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114155884 PECOS PAC ID: 2769638188 Enrollment ID: I20120817000024 |
| Provider Name | Blaine C Britt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255593265 PECOS PAC ID: 2860641792 Enrollment ID: I20121009000303 |
| Provider Name | Amber N Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194064188 PECOS PAC ID: 0042455545 Enrollment ID: I20130605000785 |
| Provider Name | Mark Timothy Barron |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1255576377 PECOS PAC ID: 2264660372 Enrollment ID: I20150203000292 |
| Provider Name | William S Hay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881952489 PECOS PAC ID: 5799917118 Enrollment ID: I20151119001968 |
| Provider Name | Candice Cliburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902257165 PECOS PAC ID: 1850686544 Enrollment ID: I20160819000528 |
| Provider Name | Megan Jarancik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225578396 PECOS PAC ID: 6406132208 Enrollment ID: I20170410002367 |
| Provider Name | Gerri L Hill Chance |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770609364 PECOS PAC ID: 1355605478 Enrollment ID: I20180425002375 |
| Provider Name | Crystal Willson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548754211 PECOS PAC ID: 2264784818 Enrollment ID: I20181009001333 |
| Provider Name | Katherine Ross Flynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639654171 PECOS PAC ID: 0547514960 Enrollment ID: I20181120003037 |
| Provider Name | Eric Tanner Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932676913 PECOS PAC ID: 3375870827 Enrollment ID: I20190807001435 |
| Provider Name | Tucker Lee Brady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679107692 PECOS PAC ID: 4981023751 Enrollment ID: I20200928001941 |
| Provider Name | Amy Katheryn Case |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033549076 PECOS PAC ID: 7517374341 Enrollment ID: I20210323002649 |
| Provider Name | Jonathan Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205505666 PECOS PAC ID: 9931505096 Enrollment ID: I20210915001131 |
| Provider Name | Meghan Lynn Case |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558980177 PECOS PAC ID: 1456713056 Enrollment ID: I20230814003710 |
| Provider Name | Anna Clair Sharp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215618806 PECOS PAC ID: 6608230073 Enrollment ID: I20230919000968 |
| Provider Name | Ashton Kyle Newman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578341459 PECOS PAC ID: 4385091552 Enrollment ID: I20231109000712 |
| Provider Name | Lakeitha M Gray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710334057 PECOS PAC ID: 5294170601 Enrollment ID: I20240226000918 |
King's Daughters Primary Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 940 Brookway Blvd, Brookhaven, MS 39601 Phone: 601-823-5000 | |
King's Daughters Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 950 Brookway Blvd, Brookhaven, MS 39601 Phone: 601-833-7973 | |
Joseph S Moak Jr Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1040 Biglane Drive, Brookhaven, MS 39601 Phone: 601-833-5051 Fax: 601-835-0240 | |
Doctors Urgent Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 439 N Jackson St, Suite A, Brookhaven, MS 39601 Phone: 601-833-9912 | |
Extended Care Clinical Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 724 N Jackson St, Brookhaven, MS 39601 Phone: 601-412-4503 | |
Alexander Jr. High School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Alexander Jr High School, 713 Beauregard St., Brookhaven, MS 39601 Phone: 601-833-7549 Fax: 601-835-5467 | |
Kdmc Pediatric Adolescent Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 509 Brookman Dr., Brookhaven, MS 39601 Phone: 601-823-5204 |