DEDRI M IVORY MD PLLC
NPI 1508229378
Internal Medicine - Rheumatology in Vicksburg, MS

Q: What is River City Medical And Arthritis Center LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Active since March 30, 2016CLIA 25D2111796 · Waiver

3510 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180(601) 501-6991(601) 501-6987 Get Directions Write a Review

NPPES record last updated: January 13, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 13, 2017, Mar 31, 2016 (2 updates tracked since 2016).

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About Dedri M Ivory Md Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEDRI M IVORY MD PLLC (NPI 1508229378) is a healthcare organization registered as a rheumatology in Vicksburg, Mississippi and active in the NPI registry since March 2016. The organization holds a CLIA Waiver certificate valid through April 14, 2028 and lists Dedri M Ivory, Owner, as its authorized official.

NPPES Registry Identity

NPI1508229378

Entity TypeOrganization

Primary Taxonomy207RR0500X

Legal Business NameRIVER CITY MEDICAL AND ARTHRITIS CENTER LLC

Location Address3510 PEMBERTON SQUARE BLVDVicksburg, MS 39180-5506

Mailing Address3510 Pemberton Square BlvdVicksburg, MS 39180-5506 · (601) 501-6991 · Fax (601) 501-6987

Phone(601) 501-6991

Fax(601) 501-6987

Organization SubpartNo

Authorized OfficialDedri M IvoryOwner · (601) 501-6991

Enumeration DateMarch 30, 2016

Last NPPES UpdateJanuary 13, 20172 updates tracked since enumeration

✔ NPI 1508229378 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians

Taxonomy Code207RR0500X

License✔ Licensed in MS · 21520

Definition

An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.

3510 PEMBERTON SQUARE BLVD, Vicksburg, MS 39180

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Other Names 1

Doing Business AsDedri M Ivory Md Pllc

Other Identifiers 3

Medicaid08551324MS

Medicare PIN529419

Medicare PIN529450ZWJH

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2111796

River City Medical And Arthritis Center LLC · Vicksburg, MS

Active · expires Apr 14, 2028

CLIA Number25D2111796

Laboratory TypePhysician Office

Certificate Effective DateApril 15, 2026

Certificate Expiration DateApril 14, 2028

Laboratory DirectorDr. Dedri M. Ivory

Laboratory Phone(601) 501-6991

Laboratory LocationRiver City Medical And Arthritis Center LLC3510 Pemberton Square Blvd, Vicksburg, MS 39180

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. DEDRI MARKITA IVORY M.D.

Internal Medicine (Rheumatology)

3510 PEMBERTON SQUARE BLVD
VICKSBURG, MS 39180

Warren County (601) 501-6991

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is River City Medical And Arthritis Center LLC's NPI number?

The NPI number for River City Medical And Arthritis Center LLC is 1508229378. It was assigned to this organization in the NPPES registry on March 30, 2016. The provider is doing business as Dedri M Ivory MD PLLC.

Where is River City Medical And Arthritis Center LLC located?

River City Medical And Arthritis Center LLC is located at 3510 Pemberton Square Blvd, Vicksburg, MS 39180. The listed phone number is (601) 501-6991.

What is River City Medical And Arthritis Center LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Does River City Medical And Arthritis Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2111796) is associated with this NPI, valid through April 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does River City Medical And Arthritis Center LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list River City Medical And Arthritis Center LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for River City Medical And Arthritis Center LLC was last updated on January 13, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.