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Organization
VICKSBURG CLINIC LLC
Active
Organization
VICKSBURG CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Mailing address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
NULL
207KA0200X
Allergy Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
Primary
—
NULL
207RI0200X
Infectious Disease Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207VX0000X
Obstetrics Physician
—
NULL
207VX0000X
Obstetrics Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
06/23/2006
Last updated
11/25/2008
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