# ROSEDALE FAMILY MEDICAL CENTER, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043223340
- **Authorized official:** DR. JOHN WILLIAM LEWIS JR. M.D. (PRESIDENT)
- **Authorized official phone:** (662) 759-6806

## Contact information

- **Practice address:** 512 LEVEE ST., ROSEDALE, MS 38769-0310
- **Practice address phone:** (662) 759-6806
- **Practice address fax:** (662) 759-6771
- **Mailing address:** P.O.BOX 310, ROSEDALE, MS 38769-0310
- **Mailing address phone:** (662) 759-6806
- **Mailing address fax:** (662) 759-6771

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 09592 | MS | Yes |

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 04/29/2008