| Obstetrics & Gynecology Associates | |
|
859 Winter St Ste A Lucedale MS 39452-6603 | |
| (601) 947-6000 | |
| Not Available |
| Full Name | Obstetrics & Gynecology Associates |
|---|---|
| Speciality | Clinic/Center |
| Location | 859 Winter St Ste A, Lucedale, Mississippi |
| Authorized Official Name and Position | Susan Rutledge (AO) |
| Authorized Official Contact | 6019471330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Obstetrics & Gynecology Associates Po Box 1007 Lucedale MS 39452-1007 Ph: (601) 947-6000 | Obstetrics & Gynecology Associates 859 Winter St Ste A Lucedale MS 39452-6603 Ph: (601) 947-6000 |
| NPI Number | 1518071570 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 02/04/2020 |
| Certification Date | 02/04/2020 |
| Medicare PECOS PAC ID | 3577549773 |
|---|---|
| Medicare Enrollment ID | O20040628001264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518071570 | NPI | - | NPPES |
| 09014803 | Medicaid | MS | |
| C02852 | Other | MS | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 207V00000X | Obstetrics & Gynecology | (NU) | Secondary |
| Provider Name | Emily Pinkerton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992942353 PECOS PAC ID: 8426114760 Enrollment ID: I20110819000396 |
| Provider Name | Jay Pinkerton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255364733 PECOS PAC ID: 3577500495 Enrollment ID: I20110823000511 |
| Provider Name | Chad E Cooley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1851731277 PECOS PAC ID: 0143544007 Enrollment ID: I20170711003661 |
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