Diane Ferguson (NPI# 1265525331, PAC ID# 1850469867) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1265525331 |
| PAC ID by PECOS | 1850469867 |
| Professional Enrollment ID | I20081003000687 |
| Full Name | Diane Ferguson |
| Organization Legal Name | SANDK MEDICAL, LLC |
| Address |
2085 Goodman Rd W Superior Health and Wellness Horn Lake MS 38637-1416 |
| Phone Number | 6622538459 |
| Gender | F |
| Medical School | UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 0446578660 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 250141 | BAPTIST MEMORIAL HOSPITAL DESOTO |
| 250167 | METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2085 Goodman Rd W, Superior Health and Wellness, Horn Lake, MS 38637-1416 | 6622538459 | SANDK MEDICAL, LLC |
| Organization Legal Name | SANDK MEDICAL, LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lanissa Odor | Nurse Practitioner | Sandk Medical, LLC | 2085 Goodman Rd W, Superior Health and Wellness, Horn Lake, MS 38637-1416 |
| Street Address |
2085 GOODMAN RD W SUPERIOR HEALTH AND WELLNESS |
| City | HORN LAKE |
| State | MS |
| Zip | 38637-1416 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lanissa Odor | Nurse Practitioner | Sandk Medical, LLC | 2085 Goodman Rd W, Superior Health and Wellness, Horn Lake, MS 38637-1416 |
| Walter Pang | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Nicole Y Monroe | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Mallory Phillips Bodford | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Achin Sharma | Family Medicine | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Timothy G Davis | Nurse Practitioner | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Zelma S Allen | Nurse Practitioner | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Lindsay Stegall Nixon | Nurse Practitioner | Convenient Care Clinic Pllc | 3040 Goodman W Rd, Horn Lake, MS 38637-1189 |
| Sandra M Newsom | Nurse Practitioner | 2906 Goodman W Rd, Suite 109, Horn Lake, MS 38637-1291 | |
| Sarita J Glover-jackson | Nurse Practitioner | Take Care Health Mississippi PC | 1501 Goodman Rd W, Horn Lake, MS 38637-1400 |
| Lori K Witmer | Nurse Practitioner | Take Care Health Mississippi PC | 1501 Goodman Rd W, Horn Lake, MS 38637-1400 |
| City | HORN LAKE |
| Zip Code | 38637 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | HORN LAKE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Diane Ferguson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.