| Madison Ridgeland Medical Clinic | |
|
12 Professional Pkwy Ridgeland MS 39157-4113 | |
| (601) 856-2460 | |
| (601) 856-4687 |
| Full Name | Madison Ridgeland Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 12 Professional Pkwy, Ridgeland, Mississippi |
| Authorized Official Name and Position | Indira K Veerisetty (OWNER) |
| Authorized Official Contact | 6018562460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Ridgeland Medical Clinic 12 Professional Pkwy Ridgeland MS 39157-4113 Ph: (601) 856-2460 | Madison Ridgeland Medical Clinic 12 Professional Pkwy Ridgeland MS 39157-4113 Ph: (601) 856-2460 |
| NPI Number | 1316128762 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 06/11/2008 |
| Medicare PECOS PAC ID | 2668543349 |
|---|---|
| Medicare Enrollment ID | O20080624000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316128762 | NPI | - | NPPES |
| 00014170 | Medicaid | MS | |
| CK4239 | Other | MS | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10202 (Mississippi) | Primary |
| Provider Name | Indira K Veerisetty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720011778 PECOS PAC ID: 2062315187 Enrollment ID: I20040128000233 |
| Provider Name | Kenneth P Kaiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073557039 PECOS PAC ID: 9133194038 Enrollment ID: I20040901001138 |
| Provider Name | Adrian B Mcclellan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336426543 PECOS PAC ID: 8729254701 Enrollment ID: I20111221000418 |
| Provider Name | Shaquita Denise Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376948075 PECOS PAC ID: 8022396936 Enrollment ID: I20161027002050 |
| Provider Name | Gagandeep Bal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578072245 PECOS PAC ID: 8921365974 Enrollment ID: I20171129000489 |
| Provider Name | Wendell Glover |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336535053 PECOS PAC ID: 6608267737 Enrollment ID: I20230531002412 |
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