River City Primary Care and Wellness Center

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

RIVER CITY PRIMARY CARE AND WELLNESS CENTER

Practice address

3702 Jefferson Ave
Pascagoula, MS 39563-6218

Phone

(228) 205-4592

Fax

(228) 205-4593

NPI assigned

Mar 14, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yolanda Long, NURSE PRACTITIONERNPI 1912302159

Title

Owner

Phone

(251) 554-6288

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yolanda Patrice Long, NURSE PRACTITIONER

  • Primary Care Nurse Practitioner
  • Pascagoula, MS
  • NPI 1912302159
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1669231676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 JEFFERSON AVE",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636218",
            "telephone_number": "228-205-4592",
            "fax_number": "228-205-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 JEFFERSON AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395636218",
            "telephone_number": "228-205-4592",
            "fax_number": "228-205-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY PRIMARY CARE AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-554-6288",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Dale Ridgeway Jr., M.D.
• Joshua T Rifkind, MD
• Ronald D Rinker, M.D.
• Carolann Risley, NP
• Walter Risley, M.D.
• Simon Georges Rizk, M.D.
• Robert B. Burns, MD
• Timothy R Robinson, ACNP
• Amy Vanderbeck Rogers, ACNP-BC
• Ronald Rosenquist, D.O.

• Multi-Specialty Clinic/Center in Pascagoula, MS
• Providers in Pascagoula, MS by specialty
• Multi-Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.