| Merit Health River Region West | |
|
1111 N Frontage Rd Vicksburg MS 39180-5102 | |
| (601) 883-5000 | |
| (601) 883-3090 |
| Full Name | Merit Health River Region West |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1111 N Frontage Rd, Vicksburg, Mississippi |
| Authorized Official Name and Position | Paula M Lalor (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Contact | 6292153953 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Merit Health River Region West Po Box 841672 Dallas TX 75284-1672 Ph: (601) 883-5000 | Merit Health River Region West 1111 N Frontage Rd Vicksburg MS 39180-5102 Ph: (601) 883-5000 |
| NPI Number | 1740228881 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 04/22/2021 |
| Certification Date | 04/22/2021 |
| Medicare PECOS PAC ID | 4688575129 |
|---|---|
| Medicare Enrollment ID | O20061108000688 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740228881 | NPI | - | NPPES |
| 1749079 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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