Starkville Pediatric Extended Care Llc

NPI Registration Record

Provider / Organization	NPI	Date Certified
STARKVILLE PEDIATRIC EXTENDED CARE LLC	1780293787	2020-07-26

The organization Starkville Pediatric Extended Care Llc is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1780293787. Registration indicates Starkville Pediatric Extended Care Llc is a provider of services with a specialization in Ambulatory Health Care Facilities, Clinic/Center (Clinic/Center: Medically Fragile Intants and Children Day Care, ) (Clinic/Center Medically Fragile Intants and Children Day Care, Ambulatory Health Care Facilities) (Clinic/Center, )

Entity Type	Organization

Provider Organization	STARKVILLE PEDIATRIC EXTENDED CARE LLC
Practice Office Address	9771 MS HIGHWAY 25 STARKVILLE, MS US
Practice Office Telephone	2512321518
Mailing Address	8178 SOLDIER CT DAPHNE, AL 365266135 US
Business Telephone	2512321518
Authorized Official	MARK HAMMOND, OWNER 2512321518

HPT Codes

Code	Practice	License No State
261QM3000X PRIMARY	Ambulatory Health Care Facilities Clinic/Center Clinic/Center: Medically Fragile Intants and Children Day Care Clinic/Center Medically Fragile Intants and Children Day Care Ambulatory Health Care Facilities Clinic/Center

OPI Codes

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