| Rh Arise Venture Of Tupelo Llc | |
|
777 Holly Hill Dr Tupelo MS 38801-2340 | |
| (662) 432-1221 | |
| Not Available |
| Full Name | Rh Arise Venture Of Tupelo Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 777 Holly Hill Dr, Tupelo, Mississippi |
| Authorized Official Name and Position | Jay Howell (CHIEF REVENUE OFFICER) |
| Authorized Official Contact | 6622055999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rh Arise Venture Of Tupelo Llc Po Box 7058 Tupelo MS 38802-7058 Ph: () - | Rh Arise Venture Of Tupelo Llc 777 Holly Hill Dr Tupelo MS 38801-2340 Ph: (662) 432-1221 |
| NPI Number | 1124776067 |
|---|---|
| Provider Enumeration Date | 03/10/2022 |
| Last Update Date | 02/05/2024 |
| Certification Date | 02/05/2024 |
| Medicare PECOS PAC ID | 2567840309 |
|---|---|
| Medicare Enrollment ID | O20220607000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124776067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Aracelis Johanna Lu Brea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164723318 PECOS PAC ID: 2860714383 Enrollment ID: I20170929000445 |
| Provider Name | Jason C Pickett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699138479 PECOS PAC ID: 7113214222 Enrollment ID: I20180227001349 |
| Provider Name | Nakimia Agnew |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184976557 PECOS PAC ID: 0648504100 Enrollment ID: I20190703000743 |
| Provider Name | Melissa K Beach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073850970 PECOS PAC ID: 3375975782 Enrollment ID: I20191122001059 |
| Provider Name | Ruth A Bibeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851983704 PECOS PAC ID: 9931517232 Enrollment ID: I20210427001555 |
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