| Northeast Ms Internal Medicine Pc | |
|
202 N 1st St Suite A Booneville MS 38829-2718 | |
| (662) 340-1138 | |
| (662) 728-5185 |
| Full Name | Northeast Ms Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 202 N 1st St, Booneville, Mississippi |
| Authorized Official Name and Position | Laurence L Dennis (PRESIDENT) |
| Authorized Official Contact | 6623401138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Ms Internal Medicine Pc 202 N 1st St Suite A Booneville MS 38829-2718 Ph: (662) 340-1138 | Northeast Ms Internal Medicine Pc 202 N 1st St Suite A Booneville MS 38829-2718 Ph: (662) 340-1138 |
| NPI Number | 1407831928 |
|---|---|
| Provider Enumeration Date | 12/07/2005 |
| Last Update Date | 06/30/2015 |
| Medicare PECOS PAC ID | 6507843356 |
|---|---|
| Medicare Enrollment ID | O20040630000694 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407831928 | NPI | - | NPPES |
| 08228702 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Marilyn Rhoads Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023092533 PECOS PAC ID: 1557348000 Enrollment ID: I20040701001327 |
| Provider Name | Laurence Leon Dennis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760466262 PECOS PAC ID: 9032196886 Enrollment ID: I20040701001393 |
| Provider Name | Samuel Mansour |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306894555 PECOS PAC ID: 7517926603 Enrollment ID: I20041005000700 |
| Provider Name | Jacqueline A Fraiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629199633 PECOS PAC ID: 3577656669 Enrollment ID: I20070905000713 |
| Provider Name | Heather Kirk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508161522 PECOS PAC ID: 2264600550 Enrollment ID: I20110712000081 |
| Provider Name | Joshua W Ramsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427502426 PECOS PAC ID: 1759679285 Enrollment ID: I20161015000000 |
| Provider Name | Michael P Hancock |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104236504 PECOS PAC ID: 8729350301 Enrollment ID: I20171003004168 |
| Provider Name | Mandar Rajaram Jagtap |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255560918 PECOS PAC ID: 4688966435 Enrollment ID: I20171003004454 |
| Provider Name | Camille Whitehead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427556828 PECOS PAC ID: 1658632831 Enrollment ID: I20180305000267 |
| Provider Name | Mary Grace Hancock |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508253295 PECOS PAC ID: 8820349848 Enrollment ID: I20181001001578 |
| Provider Name | Paige A Nabors |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396200408 PECOS PAC ID: 4587999149 Enrollment ID: I20190718001703 |
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