| Wheeler Family Medical Clinic | |
|
618 Cr 5031 Booneville MS 38829 | |
| (662) 365-0200 | |
| (662) 365-0199 |
| Full Name | Wheeler Family Medical Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 618 Cr 5031, Booneville, Mississippi |
| Authorized Official Name and Position | Marie Tyus (OFFICE MANAGER) |
| Authorized Official Contact | 6623650200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wheeler Family Medical Clinic Po Box 95 Wheeler MS 38880-0095 Ph: (662) 365-0200 | Wheeler Family Medical Clinic 618 Cr 5031 Booneville MS 38829 Ph: (662) 365-0200 |
| NPI Number | 1770672339 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 07/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770672339 | NPI | - | NPPES |
| 04071559 | Medicaid | MS | |
| C03567 | Other | CLINIC UPIN | |
| 03904817 | Medicaid | MS | |
| 04071559 | Other | MEDICAID GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | R850588 (Mississippi) | Secondary |
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