| River City Primary Care And Wellness Center | |
|
3702 Jefferson Ave Pascagoula MS 39563-6218 | |
| (228) 205-4592 | |
| (228) 205-4593 |
| Full Name | River City Primary Care And Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 3702 Jefferson Ave, Pascagoula, Mississippi |
| Authorized Official Name and Position | Yolanda Long (OWNER) |
| Authorized Official Contact | 2515546288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River City Primary Care And Wellness Center 3702 Jefferson Ave Moss Point MS 39563-6218 Ph: (228) 205-4592 | River City Primary Care And Wellness Center 3702 Jefferson Ave Pascagoula MS 39563-6218 Ph: (228) 205-4592 |
| NPI Number | 1669231676 |
|---|---|
| Provider Enumeration Date | 03/14/2024 |
| Last Update Date | 03/14/2024 |
| Medicare PECOS PAC ID | 9335581602 |
|---|---|
| Medicare Enrollment ID | O20240531002882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669231676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Yolanda Patrice Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912302159 PECOS PAC ID: 4385013994 Enrollment ID: I20240531002998 |
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