MEDICARE: PICAYUNE CLINIC 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	282NR1301X	Rural Acute Care Hospital	12086	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578564712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICAYUNE CLINIC LLC

Provider Business Mailing Address
First Line	:	801 GOODYEAR BLVD
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-3221
Country	:	US
Telephone Number	:	601-798-4711
Fax Number	:	601-749-3187

Provider Business Practice Location Address
First Line	:	801 GOODYEAR BLVD
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-3221
Country	:	US
Telephone Number	:	601-798-4711
Fax Number	:	601-749-3187

Authorized Official
Title or Position	:	CEO
Name	:	STEVE GRIMM
Credential	:
Telephone Number	:	601-798-4711

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1922066190 — PEARL RIVER EMERGENCY GROUP LLC
Practice Location Address:

801 GOODYEAR BLVD
PICAYUNE, MS
39466-3221

Practice Phone: 800-893-9698
Practice Fax:

1053350462 — FORREST COUNTY GENERAL HOSPITAL
Practice Location Address:

130 HIGHLAND PARKWAY
PICAYUNE, MS
39466-3221

Practice Phone: 601-798-4711
Practice Fax: 601-749-3187

1316980931 — PATRIZIA M. COLBERT MD
Practice Location Address:

801 GOODYEAR BLVD.
PICAYUNE, MS
39466-3221

Practice Phone: 504-554-5455
Practice Fax:

1104869353 — DR. DIRK H. DANIELSON MD
Practice Location Address:

801GOODYEAR BLVD.
PICAYUNE, MS
39466-3221

Practice Phone: 601-452-9690
Practice Fax:

1942212543 — CLIDE S SHERROD MD
Practice Location Address:

801 GOODYEAR BLVD
PICAYUNE, MS
39466-3221

Practice Phone: 601-798-4711
Practice Fax:

1649384512 — ACS EMERGENCY PHYSICIANS PA
Practice Location Address:

801 GOODYEAR BLVD
PICAYUNE, MS
39466-3221

Practice Phone: 601-798-4711
Practice Fax:

Directions to “PICAYUNE CLINIC LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.