Provider Demographics
NPI:1750654703
Name:RICE FAMILY MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:RICE FAMILY MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-628-5116
Mailing Address - Street 1:120 BURKE CALHOUN CITY RD
Mailing Address - Street 2:PO BOX 1210
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-9690
Mailing Address - Country:US
Mailing Address - Phone:662-628-5116
Mailing Address - Fax:662-628-5117
Practice Address - Street 1:120 BURKE CALHOUN CITY RD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-9690
Practice Address - Country:US
Practice Address - Phone:662-628-5116
Practice Address - Fax:662-623-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02072547Medicaid
MS1508995499OtherIND NPI