MEDICAL ASSOCIATES OF VICKSBURG PLLC (NPI# 1508278177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508278177 |
| Entity Type | Organization |
| Organization Name | MEDICAL ASSOCIATES OF VICKSBURG PLLC |
| Practice Address |
2080 S Frontage Rd Vicksburg MS 39180-5328 |
| Practice Telephone | 6012621000 |
| Practice Fax Number | 6012621006 |
| Mailing Telephone | 6012621000 |
| Mailing Fax Number | 6012621006 |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2014-05-29 |
| Authorized Official Name | DR. PAUL PIERCE III (LLC MEMBER) |
| Authorized Official Telephone | 6012621000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
2080 S FRONTAGE RD |
| 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 |
| 1700210432 | Raymond Patrick Blythe | Nurse Practitioner | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2013-08-29 |
| 1497188460 | Vicksburg Hma Physician Mgmt | Nurse Practitioner | 2080 S Frontage Rd, Ste 100, Vicksburg, MS 39180-5328 | 2013-08-14 |
| 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 |
| 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 | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497710685 | Jeffrey Morris | Internal Medicine | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2006-04-19 |
| 1114459070 | Thulasi Ram Gudi | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2017-03-30 |
| 1548557168 | Clary Ann Montalvo Galiano | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183 | 2011-07-03 |
| 1053642462 | Charles A. Marascalco | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2010-01-25 |
| 1518051705 | Feras Hamadeh | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2006-10-03 |
| 1568560530 | Joseph L Wilson | Internal Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2006-09-21 |
| 1730287707 | Joseph L Wilson Md Inc | Internal Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2006-09-21 |
| 1831120724 | Paul W Pierce | Internal Medicine | 2080 S Frontage Rd, Suite T, Vicksburg, MS 39180-5328 | 2006-07-06 |
| 1811928005 | Thomas K Sligh | Internal Medicine | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| 1770511420 | William H Wooten | Internal Medicine | 104 Mcauley Dr, Vicksburg, MS 39183-2825 | 2006-06-30 |
| Find all providers in VICKSBURG | ||||
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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.