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General NPI Number Information
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NPI Number | 1568459089
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Entity Type | Organization
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Legal Business Name | RIVER BEND MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2659 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9516
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Country | US
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Telephone | 601-933-1199
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Fax | 601-933-1116
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Provider Business Mailing Address
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Address Line | 2659 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9516
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Country | US
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Telephone | 601-933-1199
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Fax | 601-933-1116
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Authorized Official
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Title or Position | OWNER
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Name | PAIGE E KEY
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Credential | CMA XRT
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Telephone | 601-933-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | NO LICENCE NUMBER
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License Number State | MS
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