VICKSBURG CLINIC LLC (NPI# 1861622268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861622268 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Other Organization Name | RIVER REGION RURAL HEALTH - SC |
| Practice Address |
2200 Highway 61 N Vicksburg MS 39183-8246 |
| Mailing Address |
Po Box 689022 Franklin TN 37068-9022 |
| Practice Telephone | 6018833300 |
| Practice Fax Number | 6018833302 |
| Mailing Telephone | 6157788071 |
| Mailing Fax Number | 6156286877 |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2016-10-14 |
| Authorized Official Name | MICHAEL A SWAW (DIRECTOR) |
| Authorized Official Telephone | 6157788076 |
| Is Organization Subpart | Y |
| Parent Organization Name | VICKSBURG CLINIC LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| River Region Rural Health - SC | 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 |
| 1619355203 | Vicksburg Clinic LLC | Clinic/Center | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2015-05-14 |
| 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 |
2200 HIGHWAY 61 N |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39183-8246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801827019 | John David Fagan | Urology | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| 1023478435 | La Miss Diabetic Shoes | Durable Medical Equipment & Medical Supplies | 2200 Highway 61 N, Suite 3400, Vicksburg, MS 39183-8246 | 2016-02-26 |
| 1154789717 | Carrie Eure | Physician Assistant | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2016-02-10 |
| 1356593875 | Hanger Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2008-10-15 |
| 1326079518 | Alfred G Windham | Otolaryngology | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| 1750312963 | Gloria J Butler | Family Medicine | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| 1932130127 | Timothy P Kerut | Allergy & Immunology | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| 1811928005 | Thomas K Sligh | Internal Medicine | 2200 Highway 61 N, Vicksburg, MS 39183-8246 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306217823 | Tracy Curtis | Speech-Language Pathologist | 2100 Us 61, Vicksburg, MS 39183 | 2015-10-09 |
| 1649566894 | The Life Balance Clinic, Behavioral Health Service | Social Worker | 1107 B Openwood St., Vicksburg, MS 39183 | 2011-06-27 |
| 1245428788 | Melanie Joan Waldrop | Nurse Anesthetist, Certified Registered | 2100 Hwy 61n, River Region Medical Center, Vicksburg, MS 39183 | 2007-10-10 |
| 1871714477 | Robert Michael Coleman | Dentist | 2356 Grove Street, Vicksburg, MS 39183 | 2007-05-01 |
| 1942363502 | Visions Physical Therapy | Physical Therapist | 110 Holt Collier Dr, Vicksburg, MS 39183 | 2006-12-18 |
| 1023117991 | Janet S Fisher Dmd Pa | Dentist | 1212 Mission 66, Vicksburg, MS 39183 | 2006-09-21 |
| 1407878663 | Annette Bryant | Social Worker | 1107 Openwood St, Vicksburg, MS 39183 | 2006-07-24 |
| 1932168416 | Promise Hospital of Vicksburg Inc | Long Term Care Hospital | 2100 Highway 61 N Fl 6, Vicksburg, MS 39183 | 2006-03-22 |
| 1164945374 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2310 Clay St, Vicksburg, MS 39183 | 2017-07-19 |
| 1255777025 | Joyce Wanjugu Muruthi | Obstetrics & Gynecology | 2100 Highway 61 N, Vicksburg, MS 39183 | 2013-05-20 |
| Find all providers in zip 39183 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619355203 | Vicksburg Clinic LLC | Clinic/Center | 1 Medical Plaza Dr, Vicksburg, MS 39180-5187 | 2015-05-14 |
| 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 |
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|---|---|---|---|---|
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| 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.