| Vicksburg Primary Care Team Inc | |
|
1901 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-0097 | |
| (601) 629-9969 |
| Full Name | Vicksburg Primary Care Team Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1901 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Mark Stanley (PRESIDENT) |
| Authorized Official Contact | 6016360097 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicksburg Primary Care Team Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 | Vicksburg Primary Care Team Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 |
| NPI Number | 1982768222 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982768222 | NPI | - | NPPES |
| 08801241 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 13941 (Mississippi) | Primary |
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