MEDICARE: PROACTIVE MD MS 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1902474000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE MD MS LLC

Provider Business Mailing Address
First Line	:	10 CENTIMETERS DR
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-3278
Country	:	US
Telephone Number	:	864-501-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	4608 HIGHWAY 49 E
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-2318
Country	:	US
Telephone Number	:	662-590-0999
Fax Number	:

Authorized Official
Title or Position	:	ASSOC. OPERATIONS MANAGER
Name	:	JAN HOPKINS
Credential	:
Telephone Number	:	864-501-0751

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

Similar Medicare Providers

1154319481 — MRS. HELEN FOUCHE DURANT APRN
Practice Location Address:

4612 HIGHWAY 49 E
YAZOO CITY, MS
39194-2318

Practice Phone: 662-751-2535
Practice Fax: 662-751-2465

1033158118 — MRS. JUDITH CAROL PERREAULT CRNA
Practice Location Address:

16806 INNOCENTE AVE
PANAMA CITY BEACH, FL
32413-2318

Practice Phone: 850-234-1868
Practice Fax: 850-234-1468

1831276476 — JAMES D RUSSELL PA-C
Practice Location Address:

2318 PAT BOOKER RD
UNIVERSAL CITY, TX
78148-3229

Practice Phone: 210-659-0323
Practice Fax: 210-659-7668

1649345414 — MRS. CHERYL K WALTER RPT
Practice Location Address:

414 W MAIN ST
LAKE CITY, SC
29560-2318

Practice Phone: 843-374-7378
Practice Fax: 843-374-7379

1548475320 — CARLOS PORTER, MD PA
Practice Location Address:

2318 PAT BOOKER RD
UNIVERSAL CITY, TX
78148-3229

Practice Phone: 210-659-0323
Practice Fax: 210-659-7668

1699984146 — SHEILA R. REIFLE M.D.
Practice Location Address:

2318 PAT BOOKER RD
UNIVERSAL CITY, TX
78148

Practice Phone: 210-659-0323
Practice Fax: 210-659-7668

Directions to “PROACTIVE MD MS 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.