Vicksburg Special Care Clinic Llc | |
4077 Pemberton Square Blvd Vicksburg MS 39180-5580 | |
(601) 638-8600 | |
(601) 638-8661 |
Full Name | Vicksburg Special Care Clinic Llc |
---|---|
Speciality | Family Medicine |
Location | 4077 Pemberton Square Blvd, Vicksburg, Mississippi |
Authorized Official Name and Position | Mitchell Chad Barrett (OWNER/MEMBER) |
Authorized Official Contact | 6015299341 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Vicksburg Special Care Clinic Llc 4077 Pemberton Square Blvd Vicksburg MS 39180-5580 Ph: (601) 638-8600 | Vicksburg Special Care Clinic Llc 4077 Pemberton Square Blvd Vicksburg MS 39180-5580 Ph: (601) 638-8600 |
NPI Number | 1487988002 |
---|---|
Provider Enumeration Date | 09/29/2009 |
Last Update Date | 10/29/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487988002 | NPI | - | NPPES |
01483541 | Medicaid | MS | |
01123325 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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› Verified 3 days ago
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