| Westridge Family Clinic | |
|
307 S 13th Ave Laurel MS 39440-4342 | |
| (601) 649-7600 | |
| (601) 649-7628 |
| Full Name | Westridge Family Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 307 S 13th Ave, Laurel, Mississippi |
| Authorized Official Name and Position | Christopher L Mauldin (GENERAL PARTNER) |
| Authorized Official Contact | 6016497600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Westridge Family Clinic 307 S 13th Ave Laurel MS 39440-4342 Ph: (601) 649-7600 | Westridge Family Clinic 307 S 13th Ave Laurel MS 39440-4342 Ph: (601) 649-7600 |
| NPI Number | 1649479429 |
|---|---|
| Provider Enumeration Date | 07/12/2007 |
| Last Update Date | 07/12/2007 |
| Medicare PECOS PAC ID | 0648332171 |
|---|---|
| Medicare Enrollment ID | O20081217000613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649479429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 12524 (Mississippi) | Primary |
| Provider Name | Stephanie L Crosby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447299508 PECOS PAC ID: 4284618315 Enrollment ID: I20040616000773 |
| Provider Name | Christopher L Mauldin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902831837 PECOS PAC ID: 0345302873 Enrollment ID: I20101123000230 |
| Provider Name | Laura R Boleware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437540325 PECOS PAC ID: 6204143464 Enrollment ID: I20150921001238 |
| Provider Name | Charles Steven Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356834766 PECOS PAC ID: 1557605714 Enrollment ID: I20181129001789 |
| Provider Name | Madison Carol Brewer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679112304 PECOS PAC ID: 5698103604 Enrollment ID: I20200324003922 |
| Provider Name | Kaitlin Johnson Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568089977 PECOS PAC ID: 2163837097 Enrollment ID: I20210226000601 |
| Provider Name | Carrie Allison Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538872932 PECOS PAC ID: 3476926163 Enrollment ID: I20230228000752 |
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