Provider Demographics
NPI:1538215546
Name:P & S CLINIC OB-GYN PLLC
Entity type:Organization
Organization Name:P & S CLINIC OB-GYN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-256-9331
Mailing Address - Street 1:900 EARL FRYE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5507
Mailing Address - Country:US
Mailing Address - Phone:662-256-9331
Mailing Address - Fax:662-256-9335
Practice Address - Street 1:900 EARL FRYE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5507
Practice Address - Country:US
Practice Address - Phone:662-256-9331
Practice Address - Fax:662-256-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06924896Medicaid