# VINE MEDICAL ASSOCIATES LLC

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

## Provider details

- **NPI number:** 1497098651
- **Authorized official:** OLATUNJI OLUWATADE MD (CEO)
- **Authorized official phone:** (601) 883-5000

## Contact information

- **Practice address:** 2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
- **Practice address phone:** (601) 883-5000
- **Mailing address:** PO BOX 1547, SEDALIA, MO 65302-1547
- **Mailing address phone:** (660) 826-5960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/05/2013
- **Last updated:** 04/05/2013