VICKSBURG CLINIC LLC (NPI# 1619355203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619355203 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Other Organization Name | ONE MEDICAL PLAZA - RHC |
| Practice Address |
1 Medical Plaza Dr Vicksburg MS 39180-5187 |
| Mailing Address |
4000 Meridian Blvd Franklin TN 37067-6325 |
| Practice Telephone | 6018833360 |
| Practice Fax Number | 6018833364 |
| Mailing Telephone | 6154657000 |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-05-18 |
| Authorized Official Name | JAMES P WRIGHT (SENIOR DIRECTOR PHYSICAN BUSINESS) |
| Authorized Official Telephone | 6154657587 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| One Medical Plaza - RHC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659307791 | Vicksburg Clinic LLC | Surgery | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-06-23 |
| 1861622268 | Vicksburg Clinic LLC | Clinic/Center | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2009-07-20 |
| 1790915395 | Vicksburg Clinic LLC | Clinic/Center | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2009-07-17 |
| 1528298122 | Vicksburg Clinic LLC | Clinic/Center | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2009-07-17 |
| 1629279054 | Vicksburg Clinic LLC | Internal Medicine | 508 Broadway, Delhi, LA 71232-3002 | 2007-05-31 |
| 1154532257 | Vicksburg Clinic LLC | Durable Medical Equipment & Medical Supplies | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2007-05-24 |
| 1831308816 | Vicksburg Clinic LLC | Internal Medicine | 10 Crothers Dr, Ste. 4, Tallulah, LA 71282-5510 | 2007-05-22 |
| 1992722482 | Vicksburg Clinic LLC | Psychiatry & Neurology | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2006-07-17 |
| 1790711158 | Vicksburg Clinic LLC | Radiology | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2006-06-25 |
| Street Address |
1 MEDICAL PLAZA DR |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013425503 | Pathway Healthcare- Mississippi LLC | Family Medicine | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2018-01-18 |
| 1225571698 | Southern Health Network, Inc | Nurse Practitioner | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2016-12-02 |
| 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 | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861622268 | Vicksburg Clinic LLC | Clinic/Center | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2009-07-20 |
| 1790915395 | Vicksburg Clinic LLC | Clinic/Center | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2009-07-17 |
| 1528298122 | Vicksburg Clinic LLC | Clinic/Center | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2009-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730786120 | Ochsner Medical Center - Hancock, LLC | Clinic/Center | 2274 Highway 43 S Ste 200, Picayune, MS 39466-8141 | 2020-10-08 |
| 1306460282 | Covington County Hospital | Clinic/Center | 105 Eaton St, Taylorsville, MS 39168-5614 | 2020-06-05 |
| 1871117747 | Covington County Hospital | Clinic/Center | 1039 Highway 42 Ste C, Sumrall, MS 39482-4478 | 2020-06-05 |
| 1194365338 | Bounds Family Medical | Clinic/Center | 870 Main St Ste A, Fayette, MS 39069-5695 | 2020-01-15 |
| 1720649577 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 19 Third St, Belmont, MS 38827 | 2019-06-24 |
| 1255999611 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 400 3rd Ave 32 West, New Houlka, MS 38850 | 2019-05-31 |
| 1598238545 | South Sunflower County Hospital | Clinic/Center | 1001 West Delta, Moorhead, MS 38761 | 2019-01-02 |
| 1790272185 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 670 Ms-178, Suite 5, Sherman, MS 38869 | 2018-04-20 |
| 1124515515 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 2200 5th St N, Columbus, MS 39705-2212 | 2018-04-20 |
| 1205323698 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 815 2nd Ave N, Columbus, MS 39701-4703 | 2018-04-20 |
| Find all providers with the same taxonomy | ||||
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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.