| Lauderdale Medical Group Pllc | |
|
11 E Jefferson St Pontotoc MS 38863-2807 | |
| (662) 419-1260 | |
| Not Available |
| Full Name | Lauderdale Medical Group Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11 E Jefferson St, Pontotoc, Mississippi |
| Authorized Official Name and Position | Jessica Anne Lauderdale (OWNER) |
| Authorized Official Contact | 6624896041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lauderdale Medical Group Pllc 131 Emberwood Ct Tupelo MS 38801-7861 Ph: (662) 419-1260 | Lauderdale Medical Group Pllc 11 E Jefferson St Pontotoc MS 38863-2807 Ph: (662) 419-1260 |
| NPI Number | 1689456527 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 03/22/2024 |
| Medicare PECOS PAC ID | 2365890175 |
|---|---|
| Medicare Enrollment ID | O20231204002265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689456527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jessica A Lauderdale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093095523 PECOS PAC ID: 4082901228 Enrollment ID: I20170111000566 |
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