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General NPI Number Information
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NPI Number | 1659394666
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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 | 07/25/2006
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Last Update Date | 08/22/2020
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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 | 601-883-5175
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Fax | 601-883-5197
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Provider Business Mailing 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 | 601-883-5175
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Fax | 601-883-5197
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | REBECCA HURLEY
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Credential |
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Telephone | 214-473-3993
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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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