Organization
VICKSBURG ONCOLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN ZACHOW MC (PRESIDENT)
(601) 638-3005
Entity
Organization
Contact information
Practice address
970 LAKELAND DR STE 34, JACKSON, MS 39216-4640
(601) 362-0600
(601) 638-3227
Mailing address
PO BOX 4997, JACKSON, MS 39296-4997
(601) 362-0600
(601) 638-3227
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014095
—
MS
05
—
1944653
—
LA
05
—
1961817
—
LA
05
—
1961825
—
LA
01
—
91-066632
BLUE CROSS ACH
MS
Enumeration date
10/13/2006
Last updated
01/11/2019
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