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General NPI Number Information
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NPI Number | 1083345672
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Entity Type | Organization
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Legal Business Name | RIVER CITY FAMILY MEDICINE AND WEIGHT MANAGEMENT CLINIC, LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 3211 WISCONSIN AVE STE A
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City | VICKSBURG
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State | MS
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Zip | 39180-5635
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Country | US
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Telephone | 769-203-0401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 492
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City | VICKSBURG
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State | MS
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Zip | 39181-0492
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Country | US
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Telephone | 769-203-0401
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | LAMEKA MILLER
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Credential | NP
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Telephone | 769-203-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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