Provider Demographics
NPI:1649422130
Name:RIVER OAKS MANAGEMENT COMPANY, INC
Entity Type:Organization
Organization Name:RIVER OAKS MANAGEMENT COMPANY, INC
Other - Org Name:CARE PLUS PUCKETT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-3100
Mailing Address - Street 1:2550 FLOWOOD DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9303
Mailing Address - Country:US
Mailing Address - Phone:601-936-3100
Mailing Address - Fax:601-936-3130
Practice Address - Street 1:6455 HWY 18
Practice Address - Street 2:
Practice Address - City:PUCKETT
Practice Address - State:MS
Practice Address - Zip Code:39151
Practice Address - Country:US
Practice Address - Phone:601-824-9490
Practice Address - Fax:601-824-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1093189363LF0000X
MSR633283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630505104Medicaid
AL630505104Medicaid
Q73465Medicare UPIN