PICAYUNE CLINIC LLC; NPI #1578564712

Contact Information

PICAYUNE CLINIC LLC

801 GOODYEAR BLVD
PICAYUNE, MS 39466-3221

Phone: 601-798-4711
Fax: 601-749-3187
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Rural	282NR1301X

Indicates primary specialty

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NPI Profile & details for PICAYUNE CLINIC LLC

NPI # 1578564712

LBN Legal business name PICAYUNE CLINIC LLC

Authorized official STEVE GRIMM - (CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/10/2005

Last updated 08/22/2020 - About 6 years ago

Identifiers

MS	License #	12086
MS	Medicaid	00220682

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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PICAYUNE CLINIC LLC

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Specialty

Rural

NPI Profile & details for PICAYUNE CLINIC LLC

Reviews for PICAYUNE CLINIC LLC