MEDICARE: VIBHA VIG MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	13655	MS

General Provider Information

NPI Number	:	1013233857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBHA VIG MD PA

Provider Business Mailing Address
First Line	:	PO BOX 626
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-0626
Country	:	US
Telephone Number	:	601-855-5287
Fax Number	:	601-855-5130

Provider Business Practice Location Address
First Line	:	110 N JERRY CLOWER BLVD
Second Line	:	SUITE M
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-8669
Country	:	US
Telephone Number	:	601-855-5287
Fax Number	:	601-855-5130

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIBHA VIG
Credential	:	MD
Telephone Number	:	601-855-5287

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/19/2010

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