| Family Medical Center | |
|
1467 Highway 1 S Greenville MS 38701-7141 | |
| (662) 335-1621 | |
| (662) 335-8128 |
| Full Name | Family Medical Center |
|---|---|
| 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 |
|---|---|
| Family Medical Center 1467 Highway 1 S Greenville MS 38701-7141 Ph: (662) 335-1621 | Family Medical Center 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 |
| Certification 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 | (NU) | Secondary |
| 305R00000X | Preferred Provider Organization | (Mississippi) | Primary |
| Provider Name | Joe S Pulliam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952493546 PECOS PAC ID: 5991705659 Enrollment ID: I20070112000512 |
| 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 |
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