Cockrell Family Medical Center PC
Organization Active NPI Primary Care Clinic/Center · Senatobia, MS
NPI 1497705446 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1497705446
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- M17248 (MS)
- Legal business name
- COCKRELL FAMILY MEDICAL CENTER PC
- Practice address
- 120 Norfleet Dr
Senatobia, MS 38668-2220 - Phone
- (662) 301-1128
- Fax
- (662) 301-4430
- NPI assigned
- May 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Jessie Michael Cockrell, MD
- Title
- President
- Phone
- (662) 301-1128
Practitioners 3
-
Kathryn Alred, FNP-C
-
Anna Mary Meyers, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0999181 | Cockrell Family Medical Center PC | Certificate of waiver | Sep 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427000809 | MS | Part B Supplier - Clinic/Group Practice | 7517954167 |
Receives reassigned benefits from 3 practitioners Practice locations: Senatobia, MS |
National Provider Directory
Locations
562 Cutting Horse Ln
Batesville, MS 38606
Phone (662) 267-2026
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | M17248 | MS | Yes |
Addresses
Primary practice location
120 Norfleet Dr
Senatobia, MS 38668-2220
Mailing address
120 Norfleet Dr
Senatobia, MS 38668-2220
Phone (662) 301-1128
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE7710 | Other | MS | GROUP MS RAILROAD MEDICAR |
Other providers in Senatobia, MS
- Alonzo Carter
- Lorie V Chandler
- James Clark
- Clinic 221, Family Health Care, LLC
- Martha M Clinton
- Jessie Michael Cockrell
- Community Discount Pharmacy Inc
- Community Discount Pharmacy Inc
- Community Living in Mississippi - Baddour
- Compassionate Companions
All providers in Senatobia, 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 Aug 22, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.