PATHWAY HEALTHCARE- MISSISSIPPI LLC (NPI# 1013425503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013425503 |
| Entity Type | Organization |
| Organization Name | PATHWAY HEALTHCARE- MISSISSIPPI LLC |
| Practice Address |
1 Medical Plaza Dr Vicksburg MS 39180-5187 |
| Mailing Address |
37 Sandstone Cir Ste 110 Jackson TN 38305-2088 |
| Practice Telephone | 6018830264 |
| Practice Fax Number | 6018830266 |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |
| Authorized Official Name | KRYSTAL SPENCER (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 7312656025 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1 MEDICAL PLAZA DR |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225571698 | Southern Health Network, Inc | Nurse Practitioner | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2016-12-02 |
| 1619355203 | Vicksburg Clinic LLC | Clinic/Center | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2015-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215451794 | West Mississippi Medical Services | Family Medicine | 100 Mcauley Dr, Vicksburg, MS 39183-2825 | 2017-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245755990 | Pathway Healthcare- Columbus, Ms LLC | Family Medicine | 3600 Bluecutt Rd Ste 200, Columbus, MS 39705-1303 | 2017-08-03 |
| 1124471131 | 1st Step Medical PC | Family Medicine | 3104 Adams Farm Rd, Belden, MS 38826-7020 | 2016-07-14 |
| 1619981644 | Kenneth I Cronin | Family Medicine | 408 Fontaine Pl, Suite 104, Ridgeland, MS 39157-5145 | 2006-07-27 |
| 1619433943 | Live Oaks Addiction Professionals | Family Medicine | 5699 Getwell Rd Ste 1, Southaven, MS 38672-7312 | 2019-02-12 |
| 1336656628 | Pathway Healthcare- Columbus, Ms LLC | Family Medicine | 3600 Bluecutt Rd Ste 200, Columbus, MS 39705-1303 | 2018-01-08 |
| 1487179156 | Pathway Healthcare - Jackson, Ms, LLC | Family Medicine | 1551 E County Line Rd, Jackson, MS 39211-1801 | 2017-08-03 |
| 1376929901 | Sw Mediacal Inc | Family Medicine | 2561 Pass Rd, Suite D, Biloxi, MS 39531-2125 | 2015-08-05 |
| 1669697801 | William Lelon Aron Jr. | Family Medicine | 1551 E County Line Rd, Jackson, MS 39211-1801 | 2007-04-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.