S&K Medical,LLC
Organization Active NPI Family Medicine Physician · Horn Lake, MS
NPI 1396134151 · NPPES record last updated Sep 14, 2016
Key facts
- NPI
- 1396134151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- S&K MEDICAL,LLC
- Practice address
- 2085 Goodman Rd W
Horn Lake, MS 38637-1416 - Phone
- (662) 253-8459
- Fax
- (662) 253-8678
- NPI assigned
- Jan 16, 2015
- Organization subpart
- No
Authorized official
- Name
- Diane Ferguson, MD
- Title
- Owner
- Phone
- (601) 942-6902
Practitioners 2
-
Diane A Ferguson, MD
-
Lanissa Danielle Odor, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150417001003 | MS | Part B Supplier - Clinic/Group Practice | 0446578660 |
Receives reassigned benefits from 2 practitioners Practice locations: Horn Lake, MS |
National Provider Directory
Locations
5885 Airline Rd
Unit 962
Arlington, TN 38002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2085 Goodman Rd W
Horn Lake, MS 38637-1416
Mailing address
5885 Airline Rd Unit 962
Arlington, TN 38002-5121
Phone (901) 317-7427
Other names
- Superior Health and Wellness
Other providers in Horn Lake, MS
- Tiffany Shannon Ray
- Katherine Reece
- Brian Darrel Rhoads
- Arthur Thomas Roach
- Jacqueline Rueda
- Salve Family Health PC
- Achin Sharma
- Jessica White Sims
- Kathryn Derivaux Smith
- Kaila Stepter
All providers in Horn Lake, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2016. 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.