James W Speck (NPI# 1124031414, PAC ID# 3779712898) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL PRACTICE.
Nation Provider ID (NPI) | 1124031414 |
PAC ID by PECOS | 3779712898 |
Professional Enrollment ID | I20140212000229 |
Full Name | James W Speck |
Organization Legal Name | FRIENDSHIP MEDICAL CLINIC LLC |
Address |
5482 Hwy 15 N Ecru MS 38841-8471 |
Phone Number | 6624888799 |
Gender | M |
Medical School | UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE |
Graduation Year | 1967 |
Primary Specialty | GENERAL PRACTICE |
Group Practice PAC ID | 0648275024 |
Number of Group Practice Members | 4 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
250006 | BAPTIST MEMORIAL HOSPITAL UNION COUNTY |
251308 | PONTOTOC HEALTH SERVICE INC CAH |
250004 | NORTH MISSISSIPPI MEDICAL CENTER |
Address | Phone | Organization |
---|---|---|
5482 Hwy 15 N, Ecru, MS 38841-8471 | 6624888799 | FRIENDSHIP MEDICAL CLINIC LLC |
Organization Legal Name | FRIENDSHIP MEDICAL CLINIC LLC |
Physicians | 5 |
Name | Specialty | Organization | Address |
---|---|---|---|
Shelia A Sancillo Tice | Nurse Practitioner | Friendship Medical Clinic LLC | 509 State Hwy 15 S, New Albany, MS 38652-4502 |
David W Bell | Family Medicine | Friendship Medical Clinic LLC | 4127 W Main St, Tupelo, MS 38801-8129 |
Allison M Bailey | Nurse Practitioner | Friendship Medical Clinic LLC | 5482 Hwy 15 N, Ecru, MS 38841-8471 |
Jessica B. Maffett | Nurse Practitioner | Friendship Medical Clinic LLC | 509 State Hwy 15 S, New Albany, MS 38652-4502 |
Street Address |
5482 HWY 15 N |
City | ECRU |
State | MS |
Zip | 38841-8471 |
Name | Specialty | Organization | Address |
---|---|---|---|
Allison M Bailey | Nurse Practitioner | Friendship Medical Clinic LLC | 5482 Hwy 15 N, Ecru, MS 38841-8471 |
Name | Specialty | Organization | Address |
---|---|---|---|
Timothy Watson | Nurse Practitioner | Pontotoc Health Services, Inc. | 202 Main St, Ecru, MS 38841-9604 |
Stephen Q Montgomery | Family Medicine | Pontotoc Health Services, Inc. | 202 Main St, Ecru, MS 38841-9604 |
City | ECRU |
Zip Code | 38841 |
Specialty | GENERAL PRACTICE |
City + Specialty | ECRU + GENERAL PRACTICE |
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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.