| Price Dermatology | |
|
230 Trace Colony Park Dr Ste 2 Ridgeland MS 39157 | |
| (601) 992-3996 | |
| (769) 300-3112 |
| Full Name | Price Dermatology |
|---|---|
| Speciality | Clinic/Center |
| Location | 230 Trace Colony Park Dr Ste 2, Ridgeland, Mississippi |
| Authorized Official Name and Position | Richard M Price (OWNER/ ADMINISTRATOR) |
| Authorized Official Contact | 6018566024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Price Dermatology 230 Trace Colony Park Dr Ste 2 Ridgeland MS 39157-8810 Ph: (601) 992-3996 | Price Dermatology 230 Trace Colony Park Dr Ste 2 Ridgeland MS 39157 Ph: (601) 992-3996 |
| NPI Number | 1518191329 |
|---|---|
| Provider Enumeration Date | 05/07/2009 |
| Last Update Date | 05/20/2019 |
| Medicare PECOS PAC ID | 0648319962 |
|---|---|
| Medicare Enrollment ID | O20091130000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518191329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 13907 (Mississippi) | Primary |
| Provider Name | Richard M Price |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1174532790 PECOS PAC ID: 6901814052 Enrollment ID: I20060330000540 |
| Provider Name | Jena N Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558370205 PECOS PAC ID: 2860491263 Enrollment ID: I20061213000066 |
| Provider Name | Taylor Deloach Kane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407334477 PECOS PAC ID: 4981949971 Enrollment ID: I20181219002211 |
| Provider Name | Amy Heidelberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982165080 PECOS PAC ID: 3274865282 Enrollment ID: I20191024000587 |
| Provider Name | Ashley Ann Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508593690 PECOS PAC ID: 0244614956 Enrollment ID: I20220830002005 |
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