Organization
ATTICUS GROUP LLC
Active
Other names
Vital Care of Central Mississippi
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DOUGLAS HEGI (PRESIDENT)
(769) 798-7748
Entity
Organization
Contact information
Practice address
159 FOUNTAINS BLVD, SUITE B, MADISON, MS 39110-6344
(601) 859-8200
(601) 859-1057
Mailing address
159 FOUNTAINS BLVD, SUITE B, MADISON, MS 39110-6344
(601) 859-8200
(601) 859-1057
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
12242/2.1
MS
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
12242/2.1
MS
333600000X
Pharmacy
06155081
MS
3336C0004X
Compounding Pharmacy
12242/2.1
MS
3336H0001X
Home Infusion Therapy Pharmacy
Primary
12242/2.1
MS
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06155081
MEDICAID PHARMACY
MS
Enumeration date
05/23/2013
Last updated
12/02/2024
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