MEDICARE: KIMBERLY FELICIA WOMBACK RICE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	37227	TN
2	207P00000X	Emergency Medicine Physician	19047	MS
3	207P00000X	Emergency Medicine Physician	E-7028	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4112805	OTHER	TN	BLUE CROSS
2	33421	OTHER	TN	TLC TENNCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396792057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FELICIA WOMBACK RICE MD

Provider Business Mailing Address
First Line	:	8951 GOLF WALK CIR S
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8951 GOLF WALK CIR S
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8910
Country	:	US
Telephone Number	:	901-230-9278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	03/06/2014

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