Mendenhall Medical Clinic LLC
Organization Active NPI Primary Care Clinic/Center · Mendenhall, MS
NPI 1013729441 · NPPES record last updated Jan 22, 2025
Key facts
- NPI
- 1013729441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- MENDENHALL MEDICAL CLINIC LLC
- Practice address
- 3661 Simpson Highway 49
Mendenhall, MS 39114-6001 - Phone
- (601) 292-9350
- Fax
- (601) 292-9351
- NPI assigned
- Jan 22, 2025
- Organization subpart
- No
Authorized official
- Name
- Donald Garrett, NP
- Title
- NP
- Phone
- (601) 502-3574
Practitioners 3
-
Mary Lois Nevels, FNP
-
James D Polk, M.D.
-
Donald J Garrett, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250320001668 | MS | Part B Supplier - Clinic/Group Practice | 9931621844 |
Receives reassigned benefits from 2 practitioners Practice locations: Mendenhall, MS |
National Provider Directory
Locations
3661 Simpson Highway 49
Mendenhall, MS 39114
Phone (601) 292-9350
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
3661 Simpson Highway 49
Mendenhall, MS 39114-6001
Mailing address
3661 Simpson Highway 49
Mendenhall, MS 39114-6001
Phone (601) 292-9350
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- McNamed Inc.
- Mendenhall Optometric Eye Clinic, P.a.
- Jodi Miller
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- Mississippi Medical Clinic of Mendehall
- Mississippi State Department of Health
All providers in Mendenhall, MS · Primary Care Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.