Healthcare Provider Details

I. General information

NPI: 1750654703
Provider Name (Legal Business Name): RICE FAMILY MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BURKE CALHOUN CITY RD
CALHOUN CITY MS
38916-9690
US

IV. Provider business mailing address

120 BURKE CALHOUN CITY RD PO BOX 1210
CALHOUN CITY MS
38916-9690
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-5116
  • Fax: 662-623-5117
Mailing address:
  • Phone: 662-628-5116
  • Fax: 662-628-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR857851
License Number StateMS

VIII. Authorized Official

Name: MRS. MICHELLE R RICE
Title or Position: OWNER/NURSE PRACTITIONER
Credential: CFNP
Phone: 662-628-5116