| Shannon Family Medical Clinic, Llc | |
|
219 Broad St Shannon MS 38868 | |
| (662) 995-2201 | |
| (662) 995-2202 |
| Full Name | Shannon Family Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 219 Broad St, Shannon, Mississippi |
| Authorized Official Name and Position | Norris N Doss (OWNER) |
| Authorized Official Contact | 6629952201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Family Medical Clinic, Llc 219 Broad St Shannon MS 38868-9301 Ph: (662) 995-2201 | Shannon Family Medical Clinic, Llc 219 Broad St Shannon MS 38868 Ph: (662) 995-2201 |
| NPI Number | 1568633964 |
|---|---|
| Provider Enumeration Date | 03/13/2008 |
| Last Update Date | 06/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568633964 | NPI | - | NPPES |
| 05188209 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | R819576 (Mississippi) | Primary |