| Lea Ann Byrd | |
|
705 N State St Clarksdale MS 38614 | |
| (662) 627-2973 | |
| (662) 624-5595 |
| Full Name | Lea Ann Byrd |
|---|---|
| Speciality | Clinic/Center |
| Location | 705 N State St, Clarksdale, Mississippi |
| Authorized Official Name and Position | Lea Ann Byrd (OWNER) |
| Authorized Official Contact | 6626272973 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lea Ann Byrd 764 Walnut Knoll Ln Cordova TN 38018-3113 Ph: (901) 620-6397 | Lea Ann Byrd 705 N State St Clarksdale MS 38614 Ph: (662) 627-2973 |
| NPI Number | 1871098350 |
|---|---|
| Provider Enumeration Date | 03/27/2018 |
| Last Update Date | 05/17/2018 |
| Medicare PECOS PAC ID | 8325303357 |
|---|---|
| Medicare Enrollment ID | O20180523000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871098350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R823849 (Mississippi) | Primary |
| Provider Name | Vernon Thomas Hughes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427073170 PECOS PAC ID: 5890713416 Enrollment ID: I20051102000811 |
| Provider Name | Lea Ann Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407109945 PECOS PAC ID: 0244479194 Enrollment ID: I20151221001960 |
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