| Weaver Clinic, Llc | |
|
124 W Commerce St Hernando MS 38632-2240 | |
| (901) 262-0185 | |
| Not Available |
| Full Name | Weaver Clinic, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 124 W Commerce St, Hernando, Mississippi |
| Authorized Official Name and Position | Beverly Pounders Weaver (MEDICAL SUPERVISOR) |
| Authorized Official Contact | 9012620185 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Weaver Clinic, Llc 124 W Commerce St Hernando MS 38632-2240 Ph: (901) 262-0185 | Weaver Clinic, Llc 124 W Commerce St Hernando MS 38632-2240 Ph: (901) 262-0185 |
| NPI Number | 1366841066 |
|---|---|
| Provider Enumeration Date | 08/19/2014 |
| Last Update Date | 12/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366841066 | NPI | - | NPPES |
| 00122952 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | R629189 (Mississippi) | Primary |
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