| United Medical Wellness Complex, Llc | |
|
892 Centre St Ridgeland MS 39157-4509 | |
| (769) 251-2098 | |
| (800) 394-6187 |
| Full Name | United Medical Wellness Complex, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 892 Centre St, Ridgeland, Mississippi |
| Authorized Official Name and Position | Kevin Taft Wright (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6019404195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| United Medical Wellness Complex, Llc 892 Centre St Ridgeland MS 39157-4509 Ph: (769) 567-1304 | United Medical Wellness Complex, Llc 892 Centre St Ridgeland MS 39157-4509 Ph: (769) 251-2098 |
| NPI Number | 1255045324 |
|---|---|
| Provider Enumeration Date | 01/12/2023 |
| Last Update Date | 10/24/2023 |
| Medicare PECOS PAC ID | 5092171710 |
|---|---|
| Medicare Enrollment ID | O20230522002529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255045324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 405300000X | Prevention Professional | (* (Not Available)) | Secondary |
| Provider Name | Amanda B Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083040562 PECOS PAC ID: 0547277980 Enrollment ID: I20140617002012 |
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