| Rankin Primary Care Clinic, Pa | |
|
103 Service Dr Brandon MS 39042-2401 | |
| (601) 824-1491 | |
| (601) 825-9504 |
| Full Name | Rankin Primary Care Clinic, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 103 Service Dr, Brandon, Mississippi |
| Authorized Official Name and Position | Thomas L Ellingson (OWNER) |
| Authorized Official Contact | 6018241491 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rankin Primary Care Clinic, Pa Po Box 1959 Brandon MS 39043-1959 Ph: (601) 824-1491 | Rankin Primary Care Clinic, Pa 103 Service Dr Brandon MS 39042-2401 Ph: (601) 824-1491 |
| NPI Number | 1467625665 |
|---|---|
| Provider Enumeration Date | 04/08/2008 |
| Last Update Date | 04/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467625665 | NPI | - | NPPES |
| 09015199 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 16492 (Mississippi) | Primary |
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› Verified 8 days ago
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