VICKSBURG CLINIC LLC (NPI# 1629279054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629279054 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Practice Address |
508 Broadway Delhi LA 71232-3002 |
| Practice Telephone | 3188783737 |
| Mailing Telephone | 3188783737 |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2008-06-09 |
| Authorized Official Name | DEBBIE T BREWER (DIRECTOR OF PROVIDER ENRILLMENT) |
| Authorized Official Telephone | 8778929813 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1444740 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659307791 | Vicksburg Clinic LLC | Surgery | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-06-23 |
| 1619355203 | Vicksburg Clinic LLC | Clinic/Center | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2015-05-14 |
| 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 |
| 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 |
508 BROADWAY |
| City | DELHI |
| State | LA |
| Zip Code | 71232-3002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326304445 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 596 Midway Church Lane, Delhi, LA 71232 | 2012-04-03 |
| 1801196084 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 4449 Highway 17, Delhi, LA 71232 | 2010-10-22 |
| 1538477450 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 606 Midway Church Lane, Delhi, LA 71232 | 2010-09-14 |
| 1396065595 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 668 Midway Church Road, Delhi, LA 71232 | 2010-06-10 |
| 1669796447 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 652 Midway Church Lane, Delhi, LA 71232 | 2010-03-23 |
| 1346578069 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 80 Teer St, Delhi, LA 71232 | 2009-11-19 |
| 1962736967 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 98 Teer St, Delhi, LA 71232 | 2009-09-23 |
| 1457540478 | Richland Association for Retarded Citizens | Day Training, Developmentally Disabled Services | 119 Charter Street, Delhi, LA 71232 | 2007-10-16 |
| 1275738957 | Crossroads Hospice, LLC | Hospice Care, Community Based | 702 First Street, Delhi, LA 71232 | 2007-06-20 |
| 1497247191 | Audrey May | Case Manager/Care Coordinator | 712 First St, Delhi, LA 71232 | 2018-05-30 |
| Find all providers in zip 71232 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992070312 | Ivan Ronald Koota | Family Medicine | 337 Collins Ter, Delhi, NY 13753-1402 | 2012-03-19 |
| 1538133210 | Menoni Ize-iyamu | Family Medicine | 407 Cincinnati St, Delhi, LA 71232-3007 | 2006-02-17 |
| 1427042571 | Alison Theresa O'brien | Family Medicine | 460 Andes Rd, Delhi, NY 13753-7443 | 2005-09-06 |
| 1386138832 | David Keith Barron | Family Medicine | 460 Andes Rd, Delhi, NY 13753-7407 | 2018-06-19 |
| 1902281538 | Thanaseelan Muthulingam | Family Medicine | 407 Cincinnati St, Delhi, LA 71232-3007 | 2015-07-24 |
| 1821205469 | Merced Faculty Associates Medical Group Incorporated | Family Medicine | 9696 Stephens St, Delhi, CA 95315-9550 | 2007-05-16 |
| 1063436475 | Michael Nguyen | Family Medicine | 460 Andes Rd, Delhi, NY 13753-7407 | 2006-07-27 |
| 1962459008 | Baburao N Samudrala | Family Medicine | 460 Andes Rd, Physicians Office Building, Delhi, NY 13753-7407 | 2006-05-27 |
| 1912950544 | Moheb Khouzam, Md | Family Medicine | 135 Main St, Delhi, NY 13753-1219 | 2006-05-17 |
| 1336110907 | Kenneth E. Mcdonald IIi | Family Medicine | 508 Broadway St, Delhi, LA 71232-3002 | 2006-01-31 |
| Find all providers in DELHI | ||||
Please comment or provide details below to improve the information on VICKSBURG CLINIC LLC.
| 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.