Organization
UNIVERSITY SPORTS MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI G FERGUSON (CLINIC ADMINISTRATOR)
(662) 234-0424
Entity
Organization
Contact information
Practice address
2401 PROFESSIONAL DR, OXFORD, MS 38655-5374
(662) 234-0424
(662) 234-0485
Mailing address
2401 PROFESSIONAL DR, OXFORD, MS 38655-5374
(662) 234-0424
(662) 234-0485
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13319
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118675
—
MS
Enumeration date
04/01/2008
Last updated
06/24/2009
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