| South Ridge Family Clinic, Llc | |
|
80 Hal Crocker Rd Ellisville MS 39437-2089 | |
| (601) 477-2221 | |
| Not Available |
| Full Name | South Ridge Family Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 80 Hal Crocker Rd, Ellisville, Mississippi |
| Authorized Official Name and Position | Marlana Hedgepeth (OWNER) |
| Authorized Official Contact | 6014772221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Ridge Family Clinic, Llc 80 Hal Crocker Rd Ellisville MS 39437-2089 Ph: () - | South Ridge Family Clinic, Llc 80 Hal Crocker Rd Ellisville MS 39437-2089 Ph: (601) 477-2221 |
| NPI Number | 1881930469 |
|---|---|
| Provider Enumeration Date | 12/31/2012 |
| Last Update Date | 12/31/2012 |
| Medicare PECOS PAC ID | 7416194790 |
|---|---|
| Medicare Enrollment ID | O20130503000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881930469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joyce B Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770625048 PECOS PAC ID: 3375599376 Enrollment ID: I20050323000381 |
| Provider Name | Marlana P Hedgepeth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265534648 PECOS PAC ID: 2163466566 Enrollment ID: I20050616000520 |
| Provider Name | Jenna K Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962777896 PECOS PAC ID: 2668634932 Enrollment ID: I20120502000552 |
| Provider Name | Leann Nicole Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033514591 PECOS PAC ID: 2062735038 Enrollment ID: I20141223001540 |
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