| Vicksburg Clinic Llc | |
|
1907 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-1173 | |
| Not Available |
| Full Name | Vicksburg Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1907 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Jennifer L Jackson (SENIOR DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicksburg Clinic Llc 7100 Commerce Way Suite 180 Brentwood TN 37027-2829 Ph: () - | Vicksburg Clinic Llc 1907 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-1173 |
| NPI Number | 1790711158 |
|---|---|
| Provider Enumeration Date | 06/25/2006 |
| Last Update Date | 03/30/2023 |
| Medicare PECOS PAC ID | 5890696330 |
|---|---|
| Medicare Enrollment ID | O20040116000738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790711158 | NPI | - | NPPES |
| 1444596 | Medicaid | LA | |
| 1446084 | Medicaid | LA | |
| 01882015 | Medicaid | MS | |
| 09015550 | Medicaid | MS |
| Provider Name | Geri L Weiland |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700821931 PECOS PAC ID: 6204875404 Enrollment ID: I20050427000760 |
| Provider Name | Paul W Pierce |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1821005265 PECOS PAC ID: 9335181379 Enrollment ID: I20050531000749 |
| Provider Name | Craig A Cole |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659460384 PECOS PAC ID: 2668417437 Enrollment ID: I20050622000662 |
| Provider Name | Feras Hamadeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518051705 PECOS PAC ID: 4284542176 Enrollment ID: I20080602000369 |
| Provider Name | Eugene B Ferris |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1235168626 PECOS PAC ID: 5597838185 Enrollment ID: I20080715000445 |
| Provider Name | Timothy P Kerut |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1932130127 PECOS PAC ID: 6002980752 Enrollment ID: I20080730000192 |
| Provider Name | Gloria J Butler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750312963 PECOS PAC ID: 3971665589 Enrollment ID: I20081216000305 |
| Provider Name | William C Porter |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1528099413 PECOS PAC ID: 5698838423 Enrollment ID: I20090106000188 |
| Provider Name | Walter E Johnston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952332181 PECOS PAC ID: 1355407776 Enrollment ID: I20090309000575 |
| Provider Name | John D Fagan |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1801827019 PECOS PAC ID: 7012067010 Enrollment ID: I20090612000518 |
| Provider Name | Murray P Whitaker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053349373 PECOS PAC ID: 2264586759 Enrollment ID: I20090818000639 |
| Provider Name | Stanley R Easterling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154359818 PECOS PAC ID: 1254464209 Enrollment ID: I20100728000749 |
| Provider Name | Thomas K Sligh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811928005 PECOS PAC ID: 0143353003 Enrollment ID: I20100729000743 |
| Provider Name | Gordon W Sluis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831127422 PECOS PAC ID: 9335272194 Enrollment ID: I20100729000860 |
| Provider Name | Lisa D Fairchild |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033154794 PECOS PAC ID: 7618000407 Enrollment ID: I20100730000254 |
| Provider Name | Thomas C Moore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184655060 PECOS PAC ID: 1355474164 Enrollment ID: I20100730000519 |
| Provider Name | Erin S Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144547555 PECOS PAC ID: 3971636788 Enrollment ID: I20100730000549 |
| Provider Name | Deborah Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841228087 PECOS PAC ID: 7719010537 Enrollment ID: I20100730000644 |
| Provider Name | Thomas L Weeks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760427090 PECOS PAC ID: 6507999265 Enrollment ID: I20100802000202 |
| Provider Name | Sidney A Johnson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1497757603 PECOS PAC ID: 8022142405 Enrollment ID: I20100820000514 |
| Provider Name | Steven Zachow |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1518969724 PECOS PAC ID: 6103908850 Enrollment ID: I20110126000720 |
| Provider Name | Elizabeth L Herrington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306043278 PECOS PAC ID: 4284814567 Enrollment ID: I20110203000199 |
| Provider Name | Gwendolyn J Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043442254 PECOS PAC ID: 7113108945 Enrollment ID: I20110225000721 |
| Provider Name | Sarah E Williams |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598097883 PECOS PAC ID: 2567639206 Enrollment ID: I20120119000863 |
| Provider Name | Izzeddin Kamelmaz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346344421 PECOS PAC ID: 9436119179 Enrollment ID: I20120202000515 |
| Provider Name | Kenyatta N Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457633034 PECOS PAC ID: 5799943106 Enrollment ID: I20120214000728 |
| Provider Name | Marie E Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174803829 PECOS PAC ID: 4587826821 Enrollment ID: I20120502000201 |
| Provider Name | Amy C Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770876377 PECOS PAC ID: 9537323340 Enrollment ID: I20120607000111 |
| Provider Name | Miranda R Mccaskill |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1821431990 PECOS PAC ID: 4284872763 Enrollment ID: I20130522000295 |
| Provider Name | Timothy Howard Trotter |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1285602532 PECOS PAC ID: 5395751663 Enrollment ID: I20130523000018 |
| Provider Name | Tulio Figarola |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1457357691 PECOS PAC ID: 8224934393 Enrollment ID: I20140124000431 |
| Provider Name | Chasity L Torrence |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407110554 PECOS PAC ID: 2365665395 Enrollment ID: I20140521000102 |
| Provider Name | Holly M Kinget |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336376953 PECOS PAC ID: 6901026889 Enrollment ID: I20140926001175 |
| Provider Name | Alan Jeffrey Torrey |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1750693206 PECOS PAC ID: 7719299288 Enrollment ID: I20150713000735 |
| Provider Name | Christopher Hope |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275829319 PECOS PAC ID: 3870809080 Enrollment ID: I20151007001357 |
| Provider Name | Kimberly Renee Kilpatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881146306 PECOS PAC ID: 0446537617 Enrollment ID: I20170426001990 |
| Provider Name | Christopher Eugene Clark |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962704999 PECOS PAC ID: 1052582939 Enrollment ID: I20171025000616 |
| Provider Name | Kerrie Kashaun Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144695669 PECOS PAC ID: 9537425921 Enrollment ID: I20171120000305 |
| Provider Name | Declan F Hegarty |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477526945 PECOS PAC ID: 5698774719 Enrollment ID: I20180102001542 |
| Provider Name | Arie Ceville Shaw |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821355421 PECOS PAC ID: 0042456501 Enrollment ID: I20180328002860 |
| Provider Name | Allen B Yelverton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710472790 PECOS PAC ID: 0345590048 Enrollment ID: I20180829004477 |
| Provider Name | Brandon L Mizell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649624693 PECOS PAC ID: 9739468562 Enrollment ID: I20190911001720 |
| Provider Name | Karan Puri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164945812 PECOS PAC ID: 3274946876 Enrollment ID: I20201228000958 |
| Provider Name | Matthew Knight |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326139601 PECOS PAC ID: 7517130974 Enrollment ID: I20210105002006 |
| Provider Name | Joshua Holifield |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194174755 PECOS PAC ID: 5395039325 Enrollment ID: I20210623000079 |
| Provider Name | Christopher Tipton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1801282223 PECOS PAC ID: 2466763156 Enrollment ID: I20210628000074 |
| Provider Name | James Stanford |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1063866705 PECOS PAC ID: 9133412976 Enrollment ID: I20210713003784 |
| Provider Name | Candace Houston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558955344 PECOS PAC ID: 1850783648 Enrollment ID: I20220128001725 |
| Provider Name | Shelby Patricia Primeaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942870910 PECOS PAC ID: 9537554860 Enrollment ID: I20220323000079 |
| Provider Name | Niyazi Kilic |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1972096113 PECOS PAC ID: 1951783802 Enrollment ID: I20220809002256 |
| Provider Name | Kimberly Marie Zachow |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669960290 PECOS PAC ID: 4385020247 Enrollment ID: I20220929001331 |
| Provider Name | Ramon Caballero |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1851480453 PECOS PAC ID: 6901798263 Enrollment ID: I20230523000032 |
| Provider Name | Clyde Ellis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093762908 PECOS PAC ID: 4082699376 Enrollment ID: I20231130002605 |
| Provider Name | Salena Cecil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992122394 PECOS PAC ID: 1456579523 Enrollment ID: I20240517003477 |
Vicksburg Medical Teams Mht Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2080 S Frontage Rd, Suite 100, Vicksburg, MS 39180 Phone: 601-529-5466 | |
River City Family Medicine And Weight Management Clinic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3211 Wisconsin Ave Ste A, Vicksburg, MS 39180 Phone: 769-203-0401 | |
Gastrointestinal Associates, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1815 Mission 66, Vicksburg, MS 39180 Phone: 601-355-1234 Fax: 601-326-3566 | |
Robert M Cannon Md Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1901 Mission 66, Vicksburg, MS 39180 Phone: 601-636-0097 Fax: 601-629-9969 | |
Flowers Medical Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1901 Mission 66, Vicksburg, MS 39180 Phone: 601-636-0097 | |
Quad Intermed Company Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4204 Clay St, Vicksburg, MS 39183 Phone: 601-619-7717 | |
Jackson Hinds Comprehensive Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3312 Oak St, Vicksburg, MS 39180 Phone: 601-629-9500 Fax: 601-638-9044 |