Vicksburg Clinic Llc
LBN: Vicksburg Clinic Llc
Vicksburg Clinic Llc is an health care organization with primary practice located at 1907 Mission 66 , Vicksburg MS 39180-3711. The organization recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Radiation Oncology, Allopathic & Osteopathic Physicians / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Vicksburg Clinic Llc can be contacted via phone (601) 636-1173, or through Jackson, Jennifer L via phone (615) 465-7000.
Contact Information
Primary practice address
1907 Mission 66
Vicksburg MS 39180-3711
Phone: (601) 636-1173
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | ||
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X |
Profile Details
| NPI number | 1790711158 |
|---|---|
| LBN Legal business name | Vicksburg Clinic Llc |
| DBA Doing business as | |
| Authorized official | Jackson, Jennifer L |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jun 25th, 2006 |
| Last updated | Mar 30th, 2023 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790711158 | NPPES |
| Louisiana | MEDICAID | 1444596 | |
| Louisiana | MEDICAID | 1446084 | |
| Louisiana | MEDICAID | 01882015 | |
| Louisiana | MEDICAID | 09015550 |
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