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1467 Highway 1 S Greenville MS 38701-7141 | |
| (662) 335-1621 | |
| (662) 335-8128 |
| Full Name | |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 1467 Highway 1 S, Greenville, Mississippi |
| Authorized Official Name and Position | Joe S Pulliam (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 6623351621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1467 Highway 1 S Greenville MS 38701-7141 Ph: (662) 335-1621 | 1467 Highway 1 S Greenville MS 38701-7141 Ph: (662) 335-1621 |
| NPI Number | 1932197779 |
|---|---|
| Provider Enumeration Date | 10/06/2005 |
| Last Update Date | 01/27/2025 |
| Medicare PECOS PAC ID | 5395742555 |
|---|---|
| Medicare Enrollment ID | O20061031000443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932197779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 305R00000X | Preferred Provider Organization | (Mississippi) | Primary |
| Provider Name | Carrie S Janous |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275624868 PECOS PAC ID: 0941222152 Enrollment ID: I20051230000301 |
| Provider Name | Joe S Pulliam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952493546 PECOS PAC ID: 5991705659 Enrollment ID: I20070112000512 |
| Provider Name | Betsy J Cummings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578599395 PECOS PAC ID: 0840333969 Enrollment ID: I20100211000212 |
| Provider Name | Dana M Lyles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417262890 PECOS PAC ID: 6800083049 Enrollment ID: I20101214000365 |
| Provider Name | Wendy Turner Travis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881001568 PECOS PAC ID: 8921321845 Enrollment ID: I20141230001205 |
| Provider Name | Franklin Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174137111 PECOS PAC ID: 8426476532 Enrollment ID: I20200922000055 |
The Greenville Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1502 S Colorado St, Greenville, MS 38703 Phone: 662-332-9872 Fax: 662-332-9878 | |
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Dominick Trinca, M.d. Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1440 Highway 1 S, Greenville, MS 38701 Phone: 662-820-4363 | |
Np Healthcare Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 559a Highway 1 N, Greenville, MS 38701 Phone: 662-702-5159 Fax: 662-702-5164 | |
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