| Vicksburg Holistic Healthcare, Llc | |
|
919 Mission 66 Vicksburg MS 39183-2751 | |
| (601) 642-5513 | |
| Not Available |
| Full Name | Vicksburg Holistic Healthcare, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 919 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Mary Strong (FAMILY NURSE PRACTITIONER/ OWNER) |
| Authorized Official Contact | 6016131398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicksburg Holistic Healthcare, Llc Po Box 820289 Vicksburg MS 39182-0289 Ph: () - | Vicksburg Holistic Healthcare, Llc 919 Mission 66 Vicksburg MS 39183-2751 Ph: (601) 642-5513 |
| NPI Number | 1568816643 |
|---|---|
| Provider Enumeration Date | 04/14/2016 |
| Last Update Date | 04/18/2016 |
| Medicare PECOS PAC ID | 8921397456 |
|---|---|
| Medicare Enrollment ID | O20160523001209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568816643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Barbara J Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205932134 PECOS PAC ID: 0143201475 Enrollment ID: I20040525000182 |
| Provider Name | Michelle D Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811932064 PECOS PAC ID: 2567536253 Enrollment ID: I20080729000541 |
| Provider Name | Mary C Strong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114173796 PECOS PAC ID: 4789839317 Enrollment ID: I20130304000567 |
| Provider Name | Lameka Q Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720631161 PECOS PAC ID: 2668750472 Enrollment ID: I20200506000843 |
| Provider Name | Gwendolyn Royal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174298293 PECOS PAC ID: 5799182200 Enrollment ID: I20210927001780 |
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