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Organization
VICKSBURG CLINIC LLC
Active
Organization
VICKSBURG CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA MUSIC (DIRECTOR PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2085R0001X
Radiation Oncology Physician
—
NULL
2085R0001X
Radiation Oncology Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
06/25/2006
Last updated
11/20/2024
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