| Riverbend Healthcare Pllc | |
|
2011 Hwy 61 N Vicksburg MS 39183 | |
| (601) 456-2277 | |
| Not Available |
| Full Name | Riverbend Healthcare Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2011 Hwy 61 N, Vicksburg, Mississippi |
| Authorized Official Name and Position | Manivanh A Prudhomme (CEO) |
| Authorized Official Contact | 6014562277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverbend Healthcare Pllc Po Box 29841 Belfast ME 04915-2050 Ph: (601) 456-2277 | Riverbend Healthcare Pllc 2011 Hwy 61 N Vicksburg MS 39183 Ph: (601) 456-2277 |
| NPI Number | 1417620071 |
|---|---|
| Provider Enumeration Date | 07/29/2021 |
| Last Update Date | 01/17/2023 |
| Medicare PECOS PAC ID | 4688071335 |
|---|---|
| Medicare Enrollment ID | O20210922001433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417620071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Manivanh A Prudhomme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144831140 PECOS PAC ID: 0648690842 Enrollment ID: I20201008002132 |
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