VICKSBURG CLINIC LLC (NPI# 1659307791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659307791 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Practice Address |
1115 N Frontage Rd Vicksburg MS 39180-5102 |
| Practice Telephone | 6016348790 |
| Mailing Telephone | 6016348790 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2008-11-25 |
| Authorized Official Name | DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 8778929813 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207VX0000X |
Obstetrics & Gynecology Specialization: Obstetrics |
Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| Y | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015549 | 05 | |
| MS | 09015546 | 05 | |
| LA | 1111716 | 05 | |
| MS | 00720204 | 05 | |
| MS | 09015547 | 05 | |
| MS | 09015545 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
1115 N FRONTAGE RD |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154532257 | Vicksburg Clinic LLC | Durable Medical Equipment & Medical Supplies | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2007-05-24 |
| 1639259518 | Robert Clifton Strong | Anesthesiology | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-10-16 |
| 1992730998 | Rebecca Tustain | Nurse Practitioner | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-07-11 |
| 1184655060 | Thomas C Moore | Pediatrics | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-07-06 |
| 1861423766 | Philip L Scurria | Psychiatry & Neurology | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-07-06 |
| 1831127422 | Gordon W Sluis | Pediatrics | 1115 N Frontage Rd, Vicksburg, MS 39180 | 2006-06-30 |
| 1801824495 | Anita L Tribble | Internal Medicine | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-06-30 |
| 1164450755 | Gray Hilsman | Psychiatry & Neurology | 1115 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-06-30 |
| 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 | 207RI0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Infectious Disease |
| An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine. |
| 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 |
|---|---|---|---|---|
| 1497098651 | Vine Medical Associates LLC | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2013-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164721296 | Anderson Physician Alliance, Inc | Internal Medicine | 1400 20th St, Meridian, MS 39301-4111 | 2011-03-15 |
| 1417045097 | Mary Jane Burton | Internal Medicine | 1500 East Woodrow Wilson Street, Jackson, MS 39216-5199 | 2006-10-10 |
| 1003826272 | Jo P Deal | Internal Medicine | 766 Lakeland Dr, A, Jackson, MS 39216-4610 | 2006-08-09 |
| 1033131594 | Geographic Medicine Services | Internal Medicine | 180 Debuys Rd., 215, Biloxi, MS 39531 | 2006-07-24 |
| 1912928086 | Justice Aaron Gondwe | Internal Medicine | 965 J K Avent Dr, Suite 106, Grenada, MS 38901-5045 | 2006-07-22 |
| 1477580819 | Tabitha Snowdy | Internal Medicine | 766 Lakeland Dr Ste A, Jackson, MS 39216 | 2006-06-28 |
| 1023045572 | David L. Smith | Internal Medicine | 1040 River Oaks Dr Ste 303, Flowood, MS 39232-9576 | 2006-06-27 |
| 1689622318 | Anne Whitehurst | Internal Medicine | 971 Lakeland Dr Ste 954, Jackson, MS 39216-4609 | 2006-05-05 |
| 1912904590 | Jesse Pullen Penico | Internal Medicine | 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 | 2005-06-28 |
| 1104279231 | Magnolia Regional Health Center | Internal Medicine | 611 Alcorn Dr, Corinth, MS 38834-9321 | 2016-07-13 |
| 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.