| Lawrence County Family Practice | |
|
1167 E Broad St Monticello MS 39654-7682 | |
| (601) 587-1433 | |
| (601) 587-1625 |
| Full Name | Lawrence County Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1167 E Broad St, Monticello, Mississippi |
| Authorized Official Name and Position | Charla Rowley (CEO) |
| Authorized Official Contact | 6012491806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence County Family Practice Po Box 490 Mccomb MS 39649-0490 Ph: (601) 249-2701 | Lawrence County Family Practice 1167 E Broad St Monticello MS 39654-7682 Ph: (601) 587-1433 |
| NPI Number | 1245289172 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 11/06/2020 |
| Medicare PECOS PAC ID | 5193633907 |
|---|---|
| Medicare Enrollment ID | O20050629001212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245289172 | NPI | - | NPPES |
| 06870336 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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