| Revive Family Medical Clinic, Llc | |
|
3549 Bluecutt Rd Columbus MS 39705-1324 | |
| (662) 386-1541 | |
| Not Available |
| Full Name | Revive Family Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 3549 Bluecutt Rd, Columbus, Mississippi |
| Authorized Official Name and Position | Micah Alexander Grant (NURSE PRACTITIONER) |
| Authorized Official Contact | 6625704174 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Family Medical Clinic, Llc 3549 Bluecutt Rd Columbus MS 39705-1324 Ph: (662) 570-4174 | Revive Family Medical Clinic, Llc 3549 Bluecutt Rd Columbus MS 39705-1324 Ph: (662) 386-1541 |
| NPI Number | 1902577554 |
|---|---|
| Provider Enumeration Date | 09/23/2021 |
| Last Update Date | 11/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902577554 | NPI | - | NPPES |
| 06975501 | Medicaid | MS | |
| R874310 | Other | MS | MISSISSIPPI BOARD OF NURSING- RN |
| F0115273 | Other | AANP | |
| 1437558061 | Other | NPI-1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Boa Vida Hospital Of Aberdeen, Ms, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2200 5th St N, Columbus, MS 39705 Phone: 662-369-2455 | |
Jacqueline L Hampton Md Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 Baptist Blvd, Suite 304, Columbus, MS 39705 Phone: 662-327-3494 Fax: 662-327-2169 | |
Mississippi University For Women Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 620 10th St South, Cromwell Bldg Room 129, Columbus, MS 39701 Phone: 662-329-7270 Fax: 662-329-7460 | |
Internal Medicine Association, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 425 Hospital Dr, Ste 6, Columbus, MS 39705 Phone: 662-243-2008 Fax: 662-243-2017 | |
Boa Vida Hospital Of Aberdeen, Ms, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 815 2nd Ave N, Columbus, MS 39701 Phone: 662-369-2455 | |
Dutch Medical Clinics, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3654b New Hope Rd, Columbus, MS 39702 Phone: 662-329-1488 Fax: 662-329-1486 | |
Cornerstone Family Medical Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 111 Alabama St, Columbus, MS 39702 Phone: 662-570-4636 |