| Medical Associates Of Vicksburg Pllc | |
|
2080 S Frontage Rd Vicksburg MS 39180-5328 | |
| (601) 262-1000 | |
| (601) 262-1006 |
| Full Name | Medical Associates Of Vicksburg Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2080 S Frontage Rd, Vicksburg, Mississippi |
| Authorized Official Name and Position | Paul Pierce (LLC MEMBER) |
| Authorized Official Contact | 6012621000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Associates Of Vicksburg Pllc 2080 S Frontage Rd Vicksburg MS 39180-5328 Ph: (601) 262-1000 | Medical Associates Of Vicksburg Pllc 2080 S Frontage Rd Vicksburg MS 39180-5328 Ph: (601) 262-1000 |
| NPI Number | 1508278177 |
|---|---|
| Provider Enumeration Date | 05/29/2014 |
| Last Update Date | 05/29/2014 |
| Medicare PECOS PAC ID | 3577782366 |
|---|---|
| Medicare Enrollment ID | O20140909002017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508278177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph W Blackston |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194834747 PECOS PAC ID: 1658377064 Enrollment ID: I20061006000601 |
| Provider Name | Donald Clarence Faucett |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1609960889 PECOS PAC ID: 4385602705 Enrollment ID: I20070607000738 |
| Provider Name | Olatunji Jonathan Oluwatade |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1477677458 PECOS PAC ID: 8628158326 Enrollment ID: I20080115000320 |
| Provider Name | Daniel Paul Edney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699702936 PECOS PAC ID: 1254310998 Enrollment ID: I20081105000426 |
| Provider Name | Samuel Pierce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922237411 PECOS PAC ID: 0143477653 Enrollment ID: I20120905000455 |
| Provider Name | Laura E Fincher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548423023 PECOS PAC ID: 6406074327 Enrollment ID: I20140905001067 |
| Provider Name | Natasha Yvonneavion West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871992818 PECOS PAC ID: 5597016345 Enrollment ID: I20180918003601 |
| Provider Name | Amanda H Gill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598230245 PECOS PAC ID: 8022354018 Enrollment ID: I20190111002078 |
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