| Innovative Health Clinic | |
|
230 Trace Colony Park Dr Ste 1 Ridgeland MS 39157-8851 | |
| (601) 944-5585 | |
| Not Available |
| Full Name | Innovative Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 230 Trace Colony Park Dr Ste 1, Ridgeland, Mississippi |
| Authorized Official Name and Position | Stacey L Holt (CEO) |
| Authorized Official Contact | 6019445585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Health Clinic 230 Trace Colony Park Dr Ste 1 Ridgeland MS 39157-8851 Ph: (601) 944-5585 | Innovative Health Clinic 230 Trace Colony Park Dr Ste 1 Ridgeland MS 39157-8851 Ph: (601) 944-5585 |
| NPI Number | 1245904150 |
|---|---|
| Provider Enumeration Date | 08/04/2021 |
| Last Update Date | 09/23/2022 |
| Medicare PECOS PAC ID | 5991171209 |
|---|---|
| Medicare Enrollment ID | O20221011002252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245904150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Joshua D Ledford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225671456 PECOS PAC ID: 2668806191 Enrollment ID: I20191216002627 |
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