| River City Family Medicine And Weight Management Clinic, Llc | |
|
3211 Wisconsin Ave Ste A Vicksburg MS 39180-5635 | |
| (769) 203-0401 | |
| Not Available |
| Full Name | River City Family Medicine And Weight Management Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3211 Wisconsin Ave Ste A, Vicksburg, Mississippi |
| Authorized Official Name and Position | Lameka Miller (FNP) |
| Authorized Official Contact | 7692030401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River City Family Medicine And Weight Management Clinic, Llc Po Box 492 Vicksburg MS 39181-0492 Ph: (769) 203-0401 | River City Family Medicine And Weight Management Clinic, Llc 3211 Wisconsin Ave Ste A Vicksburg MS 39180-5635 Ph: (769) 203-0401 |
| NPI Number | 1083345672 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 11/29/2022 |
| Medicare PECOS PAC ID | 0143698084 |
|---|---|
| Medicare Enrollment ID | O20221123002747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083345672 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lameka Q Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720631161 PECOS PAC ID: 2668750472 Enrollment ID: I20200506000843 |
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