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General NPI Number Information
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NPI Number | 1285818005
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Entity Type | Organization
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Legal Business Name | RIDGELAND FAMILY MEDICAL CTR
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 305 HIGHWAY 51
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City | RIDGELAND
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State | MS
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Zip | 39157-3428
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Country | US
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Telephone | 601-856-9980
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Fax | 601-856-9994
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Provider Business Mailing Address
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Address Line | 305 HIGHWAY 51
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City | RIDGELAND
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State | MS
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Zip | 39157-3428
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Country | US
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Telephone | 601-856-9980
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Fax | 601-856-9994
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROLYN DURR
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Credential |
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Telephone | 601-856-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 12039
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10806
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12039
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License Number State | MS
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