Organization
STATCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA B KENNEDY (OFFICE MANAGER)
(601) 250-1122
Entity
Organization
Contact information
Practice address
1017 DELAWARE AVE, MCCOMB, MS 39648-3827
(601) 250-1122
(601) 250-0290
Mailing address
PO BOX 1909, MCCOMB, MS 39649-1909
(601) 250-1122
(601) 250-0290
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN2774
MEDICARE RAILROAD
MS
Enumeration date
05/26/2006
Last updated
10/23/2007
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