| Wellington Provider Group Pc | |
|
1000 Highland Colony Pkwy Ste 5203 Ridgeland MS 39157-2079 | |
| (859) 518-8817 | |
| (859) 201-1084 |
| Full Name | Wellington Provider Group Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Highland Colony Pkwy Ste 5203, Ridgeland, Mississippi |
| Authorized Official Name and Position | Mariela Bravo (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 8595188117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group Pc 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: (859) 518-8817 | Wellington Provider Group Pc 1000 Highland Colony Pkwy Ste 5203 Ridgeland MS 39157-2079 Ph: (859) 518-8817 |
| NPI Number | 1699487694 |
|---|---|
| Provider Enumeration Date | 12/21/2022 |
| Last Update Date | 12/21/2022 |
| Medicare PECOS PAC ID | 8123412459 |
|---|---|
| Medicare Enrollment ID | O20230522001362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699487694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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