Vicksburg Special Care Clinic Llc

LBN: Vicksburg Special Care Clinic Llc
Vicksburg Special Care Clinic Llc is an health care organization with primary practice located at 4077 Pemberton Square Blvd , Vicksburg MS 39180-5580. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Vicksburg Special Care Clinic Llc can be contacted via phone (601) 638-8600, or through Barrett, Mitchell Chad via phone (601) 529-9341.

Contact Information

Primary practice address
4077 Pemberton Square Blvd Vicksburg MS 39180-5580
Phone: (601) 638-8600
Fax: (601) 638-8661
Website:
Map and Directions
Authorized official contact:
Name: Barrett, Mitchell Chad
Phone: (601) 529-9341

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1487988002
LBN Legal business name Vicksburg Special Care Clinic Llc
DBA Doing business as
Authorized official Barrett, Mitchell Chad
Entity Organization
Organization subpart 1 No
Enumeration date Sep 29th, 2009
Last updated Oct 29th, 2014 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487988002 NPPES
Mississippi MEDICAID 01483541
Mississippi MEDICAID 01123325

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