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7908 Hwy 334 Toccopola MS 38874-0389 | |
(662) 281-8020 | |
(662) 281-8020 |
Full Name | |
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Speciality | Clinic/Center |
Location | 7908 Hwy 334, Toccopola, Mississippi |
Authorized Official Name and Position | Michelle Poole Roberts (OWNER) |
Authorized Official Contact | 6622818003 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P.o. Box 389 Toccopola MS 38874-0389 Ph: (662) 281-8003 | 7908 Hwy 334 Toccopola MS 38874-0389 Ph: (662) 281-8020 |
NPI Number | 1780715912 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 3274805023 |
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Medicare Enrollment ID | O20170815000763 |
Identifier | Type | State | Issuer |
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1780715912 | NPI | - | NPPES |
09014299 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | R549002 (Mississippi) | Secondary |
Provider Name | Michelle Poole Roberts |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861815623 PECOS PAC ID: 2264599190 Enrollment ID: I20160627001135 |