| Geri L Weiland, MD | |
|
2100 Highway 61 N, Vicksburg, MS 39183-8211 | |
| (601) 883-5000 | |
| Not Available |
| Full Name | Geri L Weiland |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 2100 Highway 61 N, Vicksburg, Mississippi |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700821931 | NPI | - | NPPES |
| 00114167 | Medicaid | MS | |
| 1331350 | Medicaid | LA | |
| 4216226 | Other | MS | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 09124 (Mississippi) | Primary |
| Entity Name | Vicksburg Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790711158 PECOS PAC ID: 5890696330 Enrollment ID: O20040116000738 |
| Mailing Address | Practice Location Address |
|---|---|
| Geri L Weiland, MD 2100 Highway 61 N, Vicksburg, MS 39183-8211 Ph: (601) 883-5000 | Geri L Weiland, MD 2100 Highway 61 N, Vicksburg, MS 39183-8211 Ph: (601) 883-5000 |
Lisa D Fairchild, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183 Phone: 601-883-5000 | |
Thomas C Moore, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1115 N Frontage Rd, Vicksburg, MS 39180 Phone: 601-634-8790 | |
Dr. Izzeddin Kamelmaz, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183 Phone: 601-883-6001 | |
Constance Phylea Barnes-woods, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183 Phone: 601-883-3391 Fax: 601-883-3318 | |
Elizabeth N Roy, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183 Phone: 601-883-5000 | |
Gordon W Sluis, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1115 N Frontage Rd, Vicksburg, MS 39180 Phone: 601-634-8790 |