| NPI | 1285894378 |
|---|---|
| Other Name | MADISON-RIDGELAND MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | WESLEY DEE GRANGER Owner 601-856-2460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 11037) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: MS 11037) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |