Vicksburg Clinic LLC

NPI #1831308816 in Tallulah, Louisiana

Provider Information

NPI Number: 1831308816
Entity Type: Organization
Organization Name: Vicksburg Clinic LLC
Primary Specialty: Family Medicine
Enumeration Date: May 22, 2007
Last Updated: Oct 1, 2008

Practice Location

Address: 10 CROTHERS DR
Address 2: STE. 4
City: Tallulah
State: Louisiana
ZIP Code: 71282-5510
Phone: (318) 574-0056

Authorized Official

Name: DEBBIE T BREWER
Title: DIRECTOR OF PROVIDER ENROLLMENT
Phone: (877) 892-9813

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Surgery	208600000X
Urology	208800000X
General Practice	208D00000X
Family Medicine	207Q00000X	Primary

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MR. Thomas A. Neumann, MD	Family Medicine	Tallulah	AI Deep Dive
DR. Ronald C. Wyche, M.D.	Family Medicine	Tallulah	AI Deep Dive
MS. Satira T Perry, M.D.	Family Medicine	Tallulah	AI Deep Dive
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Organizations

Provider Name	Specialty	City
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