| Springridge Medical Clinic | |
|
507 Springridge Rd Ste A Clinton MS 39056-5628 | |
| (601) 708-1414 | |
| (601) 708-1415 |
| Full Name | Springridge Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 507 Springridge Rd Ste A, Clinton, Mississippi |
| Authorized Official Name and Position | Shinita Reed Dudley (DR.) |
| Authorized Official Contact | 6012137681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Springridge Medical Clinic 507 Springridge Rd Ste A Clinton MS 39056-5628 Ph: (601) 708-1414 | Springridge Medical Clinic 507 Springridge Rd Ste A Clinton MS 39056-5628 Ph: (601) 708-1414 |
| NPI Number | 1689217978 |
|---|---|
| Provider Enumeration Date | 10/20/2019 |
| Last Update Date | 10/25/2022 |
| Medicare PECOS PAC ID | 3476980574 |
|---|---|
| Medicare Enrollment ID | O20200303000236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689217978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shinita Reed Dudley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154354603 PECOS PAC ID: 0547152696 Enrollment ID: I20040325000821 |
| Provider Name | Netra B Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679583991 PECOS PAC ID: 0648275198 Enrollment ID: I20060915000550 |
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