Organization
PSP MEDICAL CLINIC LLC
Active
Other names
MAGNOLIA MEDICAL CLINICS, MAGNOLIA MEDICAL CLINICS YAZOO
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PARVESH K. GOEL MD (MD)
(662) 746-3555
Entity
Organization
Contact information
Practice address
1171 HART ST, CANTON, MS 39046-4805
(601) 859-9888
(601) 859-9004
Mailing address
PO BOX 607, CANTON, MS 39046-0607
(662) 746-3555
(601) 859-9966
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
15405
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118231
—
MS
05
—
02679823
—
MS
05
—
06572715
—
MS
05
—
07228530
—
MS
05
—
09238061
—
MS
Enumeration date
05/03/2011
Last updated
02/06/2024
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