Organization
KELLY S SEGARS MD PC
Active
Other names
THE SEGARS CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MONA A MCWILLIAMS (BILLING MANAGER)
(662) 423-1000
Entity
Organization
Contact information
Practice address
1507 W QUITMAN ST, IUKA, MS 38852-1132
(662) 423-1000
(662) 423-1316
Mailing address
1507 W QUITMAN ST, IUKA, MS 38852-1132
(662) 423-1000
(662) 423-1316
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10016
MS
174400000X
Specialist
12314
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013060
—
MS
05
—
00017574
—
MS
05
—
00835093
—
MS
01
—
011800024
RAILROAD MEDICARE
MS
05
—
03171239
—
MS
05
—
04426008
—
MS
05
—
05989006
—
MS
01
—
080117421
RAILROAD MEDICARE
MS
01
—
1124298849
NPI
MS
01
—
1609871607
NPI
MS
01
—
1649429481
NPI
MS
01
—
1750386488
NPI
MS
01
—
1750387890
NPI
MS
01
—
418807663
BCBS
MS
01
—
420866905
BCBS
MS
01
—
428559600
BLUE CROSS BLUE SHIELD
MS
01
—
487623030
BCBS
MS
01
—
500001207
PTAN
MS
01
—
5121500341
PTAN
MS
01
—
5121500528
PTAN
MS
01
—
587286250
BCBS
MS
01
—
587922966
BCBS
MS
01
—
P00123795
RAILROAD MEDICARE
MS
Enumeration date
05/18/2006
Last updated
09/10/2012
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