# VICKSBURG MEDICAL TEAMS MHT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023419801
- **Authorized official:** SAM PIERCE MD (OWNER/PRESIDENT)
- **Authorized official phone:** (601) 262-1000

## Contact information

- **Practice address:** 2080 S FRONTAGE RD, SUITE 100, VICKSBURG, MS 39180-5328
- **Practice address phone:** (601) 529-5466
- **Mailing address:** 1515 HERITAGE DRIVE, SUITE 110, MCKINNEY, TX 75069-3379
- **Mailing address phone:** (817) 470-7377
- **Mailing address fax:** (877) 343-3192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2014
- **Last updated:** 01/02/2015