| Ortho Express Holding Company, Llc | |
|
806 Earl Frye Blvd Amory MS 38821-5505 | |
| (662) 478-2450 | |
| (662) 534-2330 |
| Full Name | Ortho Express Holding Company, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 806 Earl Frye Blvd, Amory, Mississippi |
| Authorized Official Name and Position | Jennifer C Bullock (PRESIDENT) |
| Authorized Official Contact | 6625342227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ortho Express Holding Company, Llc 206 Oxford Rd New Albany MS 38652-3115 Ph: (662) 534-2227 | Ortho Express Holding Company, Llc 806 Earl Frye Blvd Amory MS 38821-5505 Ph: (662) 478-2450 |
| NPI Number | 1578189973 |
|---|---|
| Provider Enumeration Date | 06/22/2020 |
| Last Update Date | 10/05/2023 |
| Medicare PECOS PAC ID | 1951724392 |
|---|---|
| Medicare Enrollment ID | O20200914001414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578189973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
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