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 |