VICKSBURG CLINIC LLC (NPI# 1790711158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790711158 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Practice Address |
1907 Mission 66 Vicksburg MS 39180-3711 |
| Mailing Address |
7100 Commerce Way Suite 180 Brentwood TN 37027-2829 |
| Practice Telephone | 6016361173 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2019-06-14 |
| Authorized Official Name | JAMES P WRIGHT (VP PHYSICIAN BUSINESS SERVICES) |
| Authorized Official Telephone | 6157781502 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1446084 | 05 | |
| MS | 09015550 | 05 | |
| LA | 1444596 | 05 | |
| MS | 01882015 | 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 |
| 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 |
| Street Address |
1907 MISSION 66 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184669798 | George Abraham | Family Medicine | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2006-06-18 |
| 1881146306 | Kimberly Renee Kilpatrick | Nurse Practitioner | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2016-11-01 |
| 1649624693 | Brandon Mizell | Emergency Medicine | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2016-04-15 |
| 1225361702 | Dallas Michelle Thomason | Physician Assistant | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2009-09-15 |
| 1528298122 | Vicksburg Clinic LLC | Clinic/Center | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2009-07-17 |
| 1952332181 | Walter E Johnston | Family Medicine | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2006-07-05 |
| 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 | 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 |
|---|---|---|---|---|
| 1831540350 | Evan Fitzgerald | Family Medicine | 13320 North Blvd, Vicksburg, MI 49097-1514 | 2016-06-27 |
| 1861772105 | First Intermed Corporation | Family Medicine | 4204 Clay Street, Vicksburg, MS 39183-0000 | 2011-08-18 |
| 1912933672 | Lara J Teal Clement | Family Medicine | 710 Newitt Vick Dr, Vicksburg, MS 39183-8746 | 2006-06-24 |
| 1184669798 | George Abraham | Family Medicine | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2006-06-18 |
| 1417999301 | Markus B Stanley | Family Medicine | 110 King Arthurs Rdg, Vicksburg, MS 39180-9767 | 2006-06-12 |
| 1386648244 | David J Schriemer | Family Medicine | 13320 N Boulevard St, Vicksburg, MI 49097-1514 | 2005-06-09 |
| 1922633916 | Physician Management Services of Mississippi, LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2020-03-10 |
| 1417410911 | Cal-med LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2019-04-11 |
| 1649755208 | Mea Primary Care Plus, LLC | Family Medicine | 4204 Clay St, Vicksburg, MS 39183-3438 | 2018-09-30 |
| 1023419801 | Vicksburg Medical Teams Mht LLC | Family Medicine | 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180-5328 | 2014-09-11 |
| Find all providers in VICKSBURG | ||||
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.