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Organization

VICKSBURG CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTY MUSIC (DIRECTOR PROVIDER ENROLLMENT)
(615) 465-7377
Entity
Organization

Contact information

Practice address
107 FRONT ST STE 1200, VIDALIA, LA 71373-2834
(318) 336-2220
(318) 336-6060
Mailing address
508 BROADWAY, DELHI, LA 71232-3002
(318) 878-3737

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
207V00000X
Obstetrics & Gynecology Physician
208600000X
Surgery Physician
Primary
208800000X
Urology Physician
208D00000X
General Practice Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1444740
LA
Enumeration date
05/31/2007
Last updated
02/14/2025
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