| Petal School Clinic | |
|
36 Panther Stadium Dr Petal MS 39465-3632 | |
| (601) 450-2144 | |
| (601) 450-2145 |
| Full Name | Petal School Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 36 Panther Stadium Dr, Petal, Mississippi |
| Authorized Official Name and Position | Kaye Ray (CHEIF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6015458700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Petal School Clinic Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-3700 | Petal School Clinic 36 Panther Stadium Dr Petal MS 39465-3632 Ph: (601) 450-2144 |
| NPI Number | 1952724650 |
|---|---|
| Provider Enumeration Date | 01/31/2014 |
| Last Update Date | 09/06/2022 |
| Medicare PECOS PAC ID | 2466342605 |
|---|---|
| Medicare Enrollment ID | O20140710000787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952724650 | NPI | - | NPPES |
| 251023 | Other | MS | MS MEDICARE PTAN |
| 02622599 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
Petal High School Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1145 Highway 42, Petal, MS 39465 Phone: 601-545-8700 Fax: 601-450-2493 | |
Central Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 126 W Central Ave, Petal, MS 39465 Phone: 601-296-2552 Fax: 601-296-2397 | |
Petal Primary School Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 60 Herrington Rd, Petal, MS 39465 Phone: 601-545-8700 Fax: 601-450-2493 | |
Runnelstown School Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 9214 Highway 42, Petal, MS 39465 Phone: 601-545-8700 Fax: 601-582-5461 | |
Immediate Care- Petal Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Parkway Ln, Petal, MS 39465 Phone: 601-705-2897 Fax: 601-584-6457 | |
Runnelstown Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 Pumping Station Rd, Petal, MS 39465 Phone: 601-583-1559 Fax: 601-583-1573 | |
Petal Middle School Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 203 Highway 42, Petal, MS 39465 Phone: 601-584-6301 Fax: 601-450-2493 |