Vicksburg Clinic LLC

NPI #1790711158 in Vicksburg, Mississippi

Provider Information

NPI Number: 1790711158
Entity Type: Organization
Organization Name: Vicksburg Clinic LLC
Primary Specialty: Family Medicine
Enumeration Date: Jun 25, 2006
Last Updated: Nov 20, 2024

Practice Location

Address: 2100 HIGHWAY 61 N
City: Vicksburg
State: Mississippi
ZIP Code: 39183-8211
Phone: (601) 883-5000

Authorized Official

Name: KRISTINA MUSIC
Title: DIRECTOR PROVIDER ENROLLMENT
Phone: (615) 465-7000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Radiology - Radiation Oncology — Radiation Oncology	2085R0001X
General Practice	208D00000X
Nurse Practitioner - Family — Family	363LF0000X
Family Medicine	207Q00000X	Primary

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