Provider Demographics
NPI:1326067588
Name:LUM, RITA KAYE (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KAYE
Last Name:LUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3626
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3626
Mailing Address - Country:US
Mailing Address - Phone:601-483-2864
Mailing Address - Fax:601-483-2806
Practice Address - Street 1:4940 HIGHWAY 39 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1019
Practice Address - Country:US
Practice Address - Phone:601-483-2864
Practice Address - Fax:601-483-2806
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS06434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113403Medicaid
MS00113403Medicaid