MEDICARE: ISLAND PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1386419141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	5831 SYLVESTER ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4073
Country	:	US
Telephone Number	:	228-218-3716
Fax Number	:

Provider Business Practice Location Address
First Line	:	5831 SYLVESTER ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4073
Country	:	US
Telephone Number	:	228-218-3716
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	ERIN CANADY BEECH
Credential	:	PA-C
Telephone Number	:	228-218-3716

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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