Provider Demographics
NPI:1427290584
Name:RIVER OAKS MANAGEMENT COMPANY, LLC
Entity type:Organization
Organization Name:RIVER OAKS MANAGEMENT COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-3121
Mailing Address - Street 1:2550 FLOWOOD DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9303
Mailing Address - Country:US
Mailing Address - Phone:601-936-3100
Mailing Address - Fax:601-936-3130
Practice Address - Street 1:1040 RIVER OAKS DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9530
Practice Address - Country:US
Practice Address - Phone:601-936-1360
Practice Address - Fax:601-936-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10101207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02454Medicare PIN