| Line Street Medical Clinic | |
|
562 Line St S Bldg A Philadelphia MS 39350-2144 | |
| (601) 389-8223 | |
| (833) 640-0468 |
| Full Name | Line Street Medical Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 562 Line St S Bldg A, Philadelphia, Mississippi |
| Authorized Official Name and Position | Sierra Cain (FNP-C/OWNER) |
| Authorized Official Contact | 6015626707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Line Street Medical Clinic 562 Line St S Bldg A Philadelphia MS 39350-2144 Ph: (601) 389-8223 | Line Street Medical Clinic 562 Line St S Bldg A Philadelphia MS 39350-2144 Ph: (601) 389-8223 |
| NPI Number | 1730811944 |
|---|---|
| Provider Enumeration Date | 06/27/2022 |
| Last Update Date | 06/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730811944 | NPI | - | NPPES |
| 01805219 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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