| MS Care Clinic, Inc | |
|
625 S Pear Orchard Rd Ste B Ridgeland MS 39157-4836 | |
| (601) 850-2200 | |
| (601) 420-0223 |
| Full Name | MS Care Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 625 S Pear Orchard Rd Ste B, Ridgeland, Mississippi |
| Authorized Official Name and Position | Amanda Greene (CEO/PRESIDENT) |
| Authorized Official Contact | 6014990282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| MS Care Clinic, Inc 625 S Pear Orchard Rd Ste B Ridgeland MS 39157-4836 Ph: (601) 499-0282 | MS Care Clinic, Inc 625 S Pear Orchard Rd Ste B Ridgeland MS 39157-4836 Ph: (601) 850-2200 |
| NPI Number | 1376168500 |
|---|---|
| Provider Enumeration Date | 06/12/2020 |
| Last Update Date | 07/28/2020 |
| Certification Date | 07/28/2020 |
| Medicare PECOS PAC ID | 7113349812 |
|---|---|
| Medicare Enrollment ID | O20200625002966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376168500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 2084N0400X | Psychiatry & Neurology - Neurology | (NU) | Secondary |
| Provider Name | Amanda B Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083040562 PECOS PAC ID: 0547277980 Enrollment ID: I20140617002012 |
| Provider Name | Kaylon Andrea Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073055695 PECOS PAC ID: 1557642485 Enrollment ID: I20170106001740 |
| Provider Name | Karen Geneva Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558853366 PECOS PAC ID: 1759713472 Enrollment ID: I20191119001921 |
| Provider Name | Elizabeth Lyle White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588514772 PECOS PAC ID: 0547741621 Enrollment ID: I20260226001572 |
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