| Vicksburg Clinic Llc | |
|
2100 Highway 61 N Vicksburg MS 39183-8211 | |
| (601) 883-5000 | |
| Not Available |
| Full Name | Vicksburg Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2100 Highway 61 N, Vicksburg, Mississippi |
| Authorized Official Name and Position | Debbie T Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8778929813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicksburg Clinic Llc 2100 Highway 61 N Vicksburg MS 39183-8211 Ph: (601) 883-5000 | Vicksburg Clinic Llc 2100 Highway 61 N Vicksburg MS 39183-8211 Ph: (601) 883-5000 |
| NPI Number | 1992722482 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 06/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992722482 | NPI | - | NPPES |
| 09015545 | Medicaid | MS | |
| 1444618 | Medicaid | LA | |
| 00720204 | Medicaid | MS | |
| 09015548 | Medicaid | MS |
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