ROBERT M CANNON MD LLC (NPI# 1174067250) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174067250 |
| Entity Type | Organization |
| Organization Name | ROBERT M CANNON MD LLC |
| Practice Address |
1901 Mission 66 Vicksburg MS 39180-3711 |
| Practice Telephone | 6016360097 |
| Practice Fax Number | 6016299969 |
| Mailing Telephone | 6016360097 |
| Mailing Fax Number | 6016299969 |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |
| Authorized Official Name | ROBERT CANNON (MD) |
| Authorized Official Telephone | 6016360097 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Street Address |
1901 MISSION 66 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023087855 | Good Samaritan Physical Therapy,inc. | Durable Medical Equipment & Medical Supplies | 1901 Mission 66, Suite A, Vicksburg, MS 39180-3711 | 2006-03-15 |
| 1922633916 | Physician Management Services of Mississippi, LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2020-03-10 |
| 1417410911 | Cal-med LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2019-04-11 |
| 1659739787 | Denesia Y Giffin Pllc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2016-02-03 |
| 1710351572 | Alliance Healthcare Services Inc | Clinic/Center | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2015-11-17 |
| 1588078737 | Christina Hossley Inc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2014-06-16 |
| 1639597966 | K Mcdaniel Inc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2014-04-03 |
| 1215373139 | Robert Michael Cannon | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2013-05-18 |
| 1326289612 | J Russell Barnes Md PC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2009-03-16 |
| 1104088152 | Carlos Alberto Latorre | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2008-07-01 |
| Find all providers in the same location | ||||
| 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 | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568816643 | Vicksburg Holistic Healthcare, LLC | Clinic/Center | 919 Mission 66, Vicksburg, MS 39183-2751 | 2016-04-14 |
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| 1720640899 | Home In The Woods Healthcare Clinic, LLC | Clinic/Center | 6572 County Road 514, Itta Bena, MS 38941-2746 | 2019-06-28 |
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| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1720559354 | Golden Years Geriatrics Inc. | Clinic/Center | 1233 County Road 108, New Albany, MS 38652-9787 | 2018-12-07 |
| 1316421373 | Children's International, LLC | Clinic/Center | 2003 Wildwood Rd, Picayune, MS 39466-2178 | 2018-09-17 |
| 1124505912 | Thaxton Family Medical Clinic LLC | Clinic/Center | 11145 Highway 6 W, Thaxton, MS 38871-9024 | 2018-07-24 |
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
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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.