SOUTH RIDGE FAMILY CLINIC, LLC (NPI# 1881930469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1881930469 |
Entity Type | Organization |
Organization Name | SOUTH RIDGE FAMILY CLINIC, LLC |
Practice Address |
80 Hal Crocker Rd Ellisville MS 39437-2089 |
Practice Telephone | 6014772221 |
Enumeration Date | 2012-12-31 |
Last Update Date | 2012-12-31 |
Authorized Official Name | MARLANA HEDGEPETH (OWNER) |
Authorized Official Telephone | 6014772221 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
Street Address |
80 HAL CROCKER RD |
City | ELLISVILLE |
State | MS |
Zip Code | 39437-2089 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265534648 | Marlana Perkins Hedgepeth | Nurse Practitioner | 80 Hal Crocker Rd, Ellisville, MS 39437-2089 | 2006-09-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
1972851814 | Dental Group of Ellisville, Pllc | Dentist | 97 Hal Crocker Road, Ellisville, MS 39437 | 2012-08-27 |
1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
Find all providers in zip 39437 |
Taxonomy Code | 207Q00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407151129 | Glenn Edward Hogancamp | Family Medicine | 35 Quail Ave., Ellisville, MO 63021 | 2011-01-12 |
1477561728 | Joseph R Danford | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2006-08-03 |
1417974080 | Jessee Crane | Family Medicine | 233 Clarkson Rd, Ellisville, MO 63011-2219 | 2006-07-17 |
1518378116 | William Currie | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2014-05-16 |
1801226287 | South Central Clinics, Inc | Family Medicine | 1203 Avenue B, Ellisville, MS 39437-2080 | 2013-11-20 |
1477748648 | Shannon L Goldsmith | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2007-09-11 |
1275735458 | Cynthia J Poelker | Family Medicine | 225 Clarkson Rd, Ellisville, MO 63011-2278 | 2007-06-01 |
1952513541 | Clarissa Jara Allen | Family Medicine | 225 Clarkson Rd, Ellisville, MO 63011-2278 | 2007-05-04 |
1457451775 | Hattiesburg Clinic Pa | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2006-09-25 |
1205844560 | Omelia Elizabeth Danford | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2006-08-03 |
Find all providers in ELLISVILLE |
City | ELLISVILLE |
Zip Code | 39437 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.