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General NPI Number Information
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NPI Number | 1740228881
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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 | 06/02/2006
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 1111 N FRONTAGE RD
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City | VICKSBURG
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State | MS
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Zip | 39180-5102
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Country | US
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Telephone | 601-883-5000
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Fax | 601-883-3090
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Provider Business Mailing Address
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Address Line | PO BOX 841672
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City | DALLAS
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State | TX
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Zip | 75284-1672
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Country | US
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Telephone | 601-883-5000
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Fax | 601-883-3090
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Authorized Official
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Title or Position | DIRECTOR/DELEGATED OFFICIAL
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Name | PAULA M LALOR
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Credential |
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Telephone | 629-215-3953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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