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General NPI Number Information
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NPI Number | 1629084058
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Entity Type | Organization
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Legal Business Name | VICKSBURG HEALTHCARE LLC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2100 HIGHWAY 61 N
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City | VICKSBURG
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State | MS
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Zip | 39183-8211
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Country | US
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Telephone | 601-883-5695
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-3000
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Fax | 615-628-6877
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Authorized Official
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Title or Position | DIRECTOR PROVIDER ENROLLMENT
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Name | KRISTY MUSIC
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Credential |
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Telephone | 615-465-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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