| Walthal Rural Health Clinic | |
|
200 Hospital Dr Tylertown MS 39667-2020 | |
| (601) 876-5303 | |
| Not Available |
| Full Name | Walthal Rural Health Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 Hospital Dr, Tylertown, Mississippi |
| Authorized Official Name and Position | Evan Dillard (PRESIDENT/CEO) |
| Authorized Official Contact | 6012884490 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Walthal Rural Health Clinic Po Box 677 Tylertown MS 39667-0677 Ph: () - | Walthal Rural Health Clinic 200 Hospital Dr Tylertown MS 39667-2020 Ph: (601) 876-5303 |
| NPI Number | 1144530403 |
|---|---|
| Provider Enumeration Date | 10/20/2010 |
| Last Update Date | 04/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144530403 | NPI | - | NPPES |
| 302G707791 | Other | MS | MEDICARE PTAN |
| 07552559 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10220 (Mississippi) | Primary |
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