| Vicksburg Clinic Llc | |
|
1115 N Frontage Rd Vicksburg MS 39180-5102 | |
| (601) 634-8790 | |
| Not Available |
| Full Name | Vicksburg Clinic Llc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 1115 N Frontage Rd, 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 1115 N Frontage Rd Vicksburg MS 39180-5102 Ph: (601) 634-8790 | Vicksburg Clinic Llc 1115 N Frontage Rd Vicksburg MS 39180-5102 Ph: (601) 634-8790 |
| NPI Number | 1659307791 |
|---|---|
| Provider Enumeration Date | 06/23/2006 |
| Last Update Date | 11/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659307791 | NPI | - | NPPES |
| 09015545 | Medicaid | MS | |
| 09015549 | Medicaid | MS | |
| 09015546 | Medicaid | MS | |
| 09015547 | Medicaid | MS | |
| 1111716 | Medicaid | LA | |
| 00720204 | Medicaid | MS |
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