| Northstar Healthcare-beta Llc | |
|
1060 E County Line Rd Ste 6 Ridgeland MS 39157-1937 | |
| (601) 438-2678 | |
| (601) 438-2679 |
| Full Name | Northstar Healthcare-beta Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1060 E County Line Rd Ste 6, Ridgeland, Mississippi |
| Authorized Official Name and Position | Kelsey Blevins (NATIONAL DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9013783561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northstar Healthcare-beta Llc 1060 E County Line Rd Ste 6 Ridgeland MS 39157-1937 Ph: (601) 438-2678 | Northstar Healthcare-beta Llc 1060 E County Line Rd Ste 6 Ridgeland MS 39157-1937 Ph: (601) 438-2678 |
| NPI Number | 1982299012 |
|---|---|
| Provider Enumeration Date | 03/01/2021 |
| Last Update Date | 04/13/2021 |
| Medicare PECOS PAC ID | 8325456254 |
|---|---|
| Medicare Enrollment ID | O20210414001640 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982299012 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Matthew T Tipton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992060669 PECOS PAC ID: 1456576289 Enrollment ID: I20140710000607 |
| Provider Name | Shanna Pettie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093978918 PECOS PAC ID: 3375772072 Enrollment ID: I20150805007147 |
| Provider Name | Aaron A Amos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003059874 PECOS PAC ID: 7214085729 Enrollment ID: I20150825004101 |
| Provider Name | Michelle G Briley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336789387 PECOS PAC ID: 7315369840 Enrollment ID: I20200629003693 |
| Provider Name | Brian C Gibbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154953107 PECOS PAC ID: 3173717352 Enrollment ID: I20200722000356 |
| Provider Name | Cris A Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306454442 PECOS PAC ID: 3577962976 Enrollment ID: I20210603002976 |
| Provider Name | Jessica Faye Skinner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952071227 PECOS PAC ID: 6608274063 Enrollment ID: I20211015000333 |
| Provider Name | Laura Ashley Rhea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255004073 PECOS PAC ID: 1759779820 Enrollment ID: I20211021001843 |
| Provider Name | Christy Makurat-coon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528649878 PECOS PAC ID: 7214326651 Enrollment ID: I20211105000718 |
| Provider Name | Tanya K Mccaskill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396383238 PECOS PAC ID: 8123216892 Enrollment ID: I20211112001376 |
| Provider Name | Tiffany Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992433163 PECOS PAC ID: 2163806407 Enrollment ID: I20220906000214 |
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