1184663528 NPI number — BARBARA L RICKS MD

Table of content: BARBARA L RICKS MD (NPI 1184663528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184663528 NPI number — BARBARA L RICKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICKS
Provider First Name:
BARBARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184663528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1693 FAIRGROUNDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38703-7810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-725-2749
Provider Business Mailing Address Fax Number:
662-725-2741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
526 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-332-0501
Provider Business Practice Location Address Fax Number:
662-332-0176
Provider Enumeration Date:
06/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  16166 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1550787 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00120460 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".