VICKSBURG HMA PHYSICIAN MGMT (NPI# 1497188460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497188460 |
| Entity Type | Organization |
| Organization Name | VICKSBURG HMA PHYSICIAN MGMT |
| Other Organization Name | MEDICAL ASSOCIATES OF VICKSBURG |
| Practice Address |
2080 S Frontage Rd Ste 100 Vicksburg MS 39180-5328 |
| Practice Telephone | 6012621000 |
| Practice Fax Number | 6012621211 |
| Mailing Telephone | 6012621000 |
| Mailing Fax Number | 6012621211 |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |
| Authorized Official Name | JOHN H MOORE (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 6012621000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R871321 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Medical Associates of Vicksburg | Doing Business As Name - Organization |
| Street Address |
2080 S FRONTAGE RD STE 100 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497710685 | Jeffrey Morris | Internal Medicine | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2006-04-19 |
| 1477915718 | Johanna Kimberl | Physician Assistant | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2016-03-25 |
| 1114387123 | Baleigh Ford | Physician Assistant | 2080 S Frontage Rd, #100, Vicksburg, MS 39180-5328 | 2016-03-03 |
| 1134593361 | Robert C. Clingan, Md, Dermatology | Clinic/Center | 2080 S Frontage Rd, Suite 113, Vicksburg, MS 39180-5328 | 2015-11-27 |
| 1023419801 | Vicksburg Medical Teams Mht LLC | Family Medicine | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2014-09-11 |
| 1508278177 | Medical Associates of Vicksburg Pllc | Internal Medicine | 2080 S Frontage Rd, Vicksburg, MS 39180-5328 | 2014-05-29 |
| 1700210432 | Raymond Patrick Blythe | Nurse Practitioner | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2013-08-29 |
| 1720372345 | River Oaks Management Company, LLC | Otolaryngology | 2080 S Frontage Rd, Vicksburg, MS 39180-5328 | 2011-05-31 |
| 1659503878 | Battlefield Compounding Center Incorporated | Pharmacy | 2080 S Frontage Rd, Suite 101a, Vicksburg, MS 39180-5328 | 2009-08-21 |
| 1740412964 | Battlefield Express Drugs Incorporated | Pharmacy | 2080 S Frontage Rd, Suite 101, Vicksburg, MS 39180-5328 | 2009-08-21 |
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| 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 | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144831140 | Manivanh Prudhomme | Nurse Practitioner | 109 Airline Drive, Vicksburg, MS 39180-3918 | 2020-08-12 |
| 1225532450 | Tabitha Nicole Allen | Nurse Practitioner | 2080 S Frontage Rd Ste 106, Vicksburg, MS 39180-5882 | 2018-03-21 |
| 1164971131 | Janine Gibbs Larry | Nurse Practitioner | 139 Watkins Rd, Vicksburg, MS 39180-7291 | 2016-09-30 |
| 1326434564 | Elizabeth Hill | Nurse Practitioner | 4204 Clay St, Vicksburg, MS 39183-3438 | 2015-04-14 |
| 1033522073 | Aubri Bailey Hickman | Nurse Practitioner | 2050 Birdsong Rd, Vicksburg, MS 39183-9200 | 2014-06-07 |
| 1891894101 | Bonnie Lee Morehead | Nurse Practitioner | 204 Duval St, Vicksburg, MS 39183-8207 | 2006-09-22 |
| 1598230245 | Amanda Henson Gill | Nurse Practitioner | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180-5883 | 2018-10-09 |
| 1205343803 | Tonette Harris-haynes | Nurse Practitioner | 2850 Porters Chapel Rd, Vicksburg, MS 39180-1805 | 2018-01-04 |
| 1881146306 | Kimberly Renee Kilpatrick | Nurse Practitioner | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2016-11-01 |
| 1659739787 | Denesia Y Giffin Pllc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2016-02-03 |
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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.