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 |
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Provider Enumeration Date | 11/14/2007 |
Last Update Date | 06/11/2008 |
Medicare PECOS PAC ID | 2668543349 |
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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 |
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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 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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