| Beanstalk Pediatrics, Pllc | |
|
320 W Jackson St Ridgeland MS 39157-2222 | |
| (769) 567-1527 | |
| Not Available |
| Full Name | Beanstalk Pediatrics, Pllc |
|---|---|
| Speciality | Pediatrics |
| Location | 320 W Jackson St, Ridgeland, Mississippi |
| Authorized Official Name and Position | Constance P Barnes-woods (OWNER) |
| Authorized Official Contact | 7695671527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beanstalk Pediatrics, Pllc 320 W Jackson St Ridgeland MS 39157-2222 Ph: (769) 567-1527 | Beanstalk Pediatrics, Pllc 320 W Jackson St Ridgeland MS 39157-2222 Ph: (769) 567-1527 |
| NPI Number | 1740967520 |
|---|---|
| Provider Enumeration Date | 07/03/2023 |
| Last Update Date | 06/03/2025 |
| Medicare PECOS PAC ID | 3274993522 |
|---|---|
| Medicare Enrollment ID | O20230718001836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740967520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Constance Barnes-woods |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538521901 PECOS PAC ID: 3870888241 Enrollment ID: I20190801000778 |
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