| Psp Medical Clinic Llc | |
|
1171 Hart St Canton MS 39046-4805 | |
| (601) 859-9888 | |
| (601) 859-9004 |
| Full Name | Psp Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1171 Hart St, Canton, Mississippi |
| Authorized Official Name and Position | Parvesh K. Goel (MD) |
| Authorized Official Contact | 6627463555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psp Medical Clinic Llc Po Box 607 Canton MS 39046-0607 Ph: (662) 746-3555 | Psp Medical Clinic Llc 1171 Hart St Canton MS 39046-4805 Ph: (601) 859-9888 |
| NPI Number | 1225320708 |
|---|---|
| Provider Enumeration Date | 05/03/2011 |
| Last Update Date | 02/06/2024 |
| Medicare PECOS PAC ID | 6406859446 |
|---|---|
| Medicare Enrollment ID | O20110909002842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225320708 | NPI | - | NPPES |
| 06572715 | Medicaid | MS | |
| 07228530 | Medicaid | MS | |
| 00118231 | Medicaid | MS | |
| 02679823 | Medicaid | MS | |
| 09238061 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 15405 (Mississippi) | Primary |
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