VICKSBURG CLINIC LLC (NPI# 1992722482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992722482 |
| Entity Type | Organization |
| Organization Name | VICKSBURG CLINIC LLC |
| Practice Address |
2100 Highway 61 N Vicksburg MS 39183-8211 |
| Practice Telephone | 6018835000 |
| Mailing Telephone | 6018835000 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-06-09 |
| 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 | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015545 | 05 | |
| MS | 00720204 | 05 | |
| LA | 1444618 | 05 | |
| MS | 09015548 | 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 |
| 1790711158 | Vicksburg Clinic LLC | Radiology | 1907 Mission 66, Vicksburg, MS 39180-3711 | 2006-06-25 |
| Street Address |
2100 HIGHWAY 61 N |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39183-8211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457357691 | Tulio Figarola | Orthopaedic Surgery | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2005-06-22 |
| 1639799430 | Vicksburg Healthcare LLC | Clinical Medical Laboratory | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2020-04-21 |
| 1407481880 | Casey Elaine Collier | Physician Assistant | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2020-03-06 |
| 1124682570 | Kpc Promise Hospital of Vicksburg LLC | Long Term Care Hospital | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2019-04-30 |
| 1144789801 | Laura Lavee Burris | Physician Assistant | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2019-03-12 |
| 1134699192 | Lisa Wamsley | Pharmacist | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2018-12-03 |
| 1619456621 | Kimberly Washington | Physical Therapist | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2018-08-09 |
| 1114459070 | Thulasi Ram Gudi | Internal Medicine | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2017-03-30 |
| 1518403617 | Brett Myers Scruggs | Nurse Anesthetist, Certified Registered | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2017-01-12 |
| 1770933731 | Cesar Luis Merino | Hospitalist | 2100 Highway 61 N, Vicksburg, MS 39183-8211 | 2016-06-20 |
| Find all providers in the same location | ||||
| 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 |
| 1811244858 | Life Balance Clinic LLC | Social Worker | 1107 Openwood St, Vicksburg, MS 39183 | 2012-08-09 |
| Find all providers in zip 39183 | ||||
| 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 | ||||
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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.