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Organization

PSP MEDICAL CLINIC

Active
Other names
Magnolia Medical Clinics, Gluckstadt Family Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
PARVESH K. GOEL MD (MD)
(601) 707-5621
Entity
Organization

Contact information

Practice address
1082A GLUCKSTADT RD, MADISON, MS 39110-7243
(601) 707-5621
Mailing address
PO BOX 607, CANTON, MS 39046
(601) 859-9888
(601) 859-9966

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
25D1087086
CLIA
MS
Enumeration date
09/28/2012
Last updated
04/06/2021
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