| South Rankin Family Clinic, Llc | |
|
368 Scarbrough St Suite B Richland MS 39218-9038 | |
| (601) 664-2273 | |
| (601) 664-3472 |
| Full Name | South Rankin Family Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 368 Scarbrough St, Richland, Mississippi |
| Authorized Official Name and Position | Roderick Anthony Shields (OWNER) |
| Authorized Official Contact | 6016642273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Rankin Family Clinic, Llc 368 Scarbrough St Suite B Richland MS 39218-9038 Ph: (601) 664-2273 | South Rankin Family Clinic, Llc 368 Scarbrough St Suite B Richland MS 39218-9038 Ph: (601) 664-2273 |
| NPI Number | 1629143334 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2567463862 |
|---|---|
| Medicare Enrollment ID | O20070130000340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629143334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 12884 (Mississippi) | Primary |
| Provider Name | Roderick A Shields |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760436570 PECOS PAC ID: 1557323177 Enrollment ID: I20041123000425 |
| Provider Name | Cindy S Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699022392 PECOS PAC ID: 7315198777 Enrollment ID: I20121112000261 |
| Provider Name | Bradley K Shields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073086005 PECOS PAC ID: 5698196301 Enrollment ID: I20200604003302 |
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