Madison-Ridgeland Medical Clinic
LBN: Wesley Dee Granger, M.D., P.A.
Madison-Ridgeland Medical Clinic is an health care organization with primary practice located at 12 Professional Pkwy , Ridgeland MS 39157-4113. The organization recently has 2 registered licenses in different health care specialties including Managed Care Organizations / Preferred Provider Organization, Managed Care Organizations / Point of Service. Managed Care Organizations / Preferred Provider Organization is the primary health care specialty.
Wesley Dee Granger, M.D., P.A. can be contacted via phone (601) 856-2460, or through Granger, Wesley Dee via phone (601) 856-2460.
Contact Information
Primary practice address
12 Professional Pkwy
Ridgeland MS 39157-4113
Phone: (601) 856-2460
Fax: (601) 856-4687
Website:
Authorized official contact:
Name: Granger, Wesley Dee Doctor of Medicine (MD)
Phone: (601) 856-2460
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Managed Care Organizations / Preferred Provider Organization | 305R00000X | 11037 | Mississippi |
| Managed Care Organizations / Point of Service | 305S00000X | 11037 | Mississippi |
Profile Details
| NPI number | 1285894378 |
|---|---|
| LBN Legal business name | Wesley Dee Granger, M.D., P.A. |
| DBA Doing business as | Madison-Ridgeland Medical Clinic |
| Authorized official | Granger, Wesley Dee Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jun 11th, 2008 |
| Last updated | Jun 11th, 2008 - about 17 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285894378 | NPPES |
| Mississippi | MEDICAID | 00017026 |
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