| Gordon W Sluis, MD | |
|
1115 N Frontage Rd, Vicksburg, MS 39180 | |
| (601) 634-8790 | |
| Not Available |
| Full Name | Gordon W Sluis |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 1115 N Frontage Rd, 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 |
|---|---|---|---|
| 1831127422 | NPI | - | NPPES |
| 4627838 | Other | MS | AETNA |
| 1331287 | Medicaid | LA | |
| 00013539 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 09812 (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 |
|---|---|
| Gordon W Sluis, MD 2200 Highway 61 N, Vicksburg, MS 39183-8246 Ph: (601) 883-4133 | Gordon W Sluis, MD 1115 N Frontage Rd, Vicksburg, MS 39180 Ph: (601) 634-8790 |
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 | |
Geri L Weiland, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183 Phone: 601-883-5000 |