NPIMap

Organization Active NPI

Vicksburg Nephrology LLC

  • Nephrology Physician
  • Vicksburg, MS
National Provider Identifier
1013337658
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
VICKSBURG NEPHROLOGY LLC
Practice address
104 McAuley Dr
Vicksburg, MS 39183-2825
Phone
(601) 738-5549
Fax
(601) 630-9120
NPI assigned
Apr 22, 2014
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Michael L Davis, MDNPI 1033147442
Title
Owner
Phone
(601) 738-5549

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20140625002168 MS Part B Supplier - Clinic/Group Practice 9032334578 Receives reassigned benefits from 6 practitioners
Practice locations: Vicksburg, MS
O20150722005701 LA Part B Supplier - Clinic/Group Practice 9032334578 Receives reassigned benefits from 5 practitioners
Practice locations: Delta, LA

National Provider Directory

National Provider Directory

Locations

1003 Mission Park Dr
Vicksburg, MS 39180
Phone (601) 299-5605

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GFEFCD

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

NPPES NPI Registry

Primary practice location

104 McAuley Dr
Vicksburg, MS 39183-2825

Mailing address

PO Box 820663
Vicksburg, MS 39182-0663
Phone (601) 738-5549

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 22, 2014.

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1013337658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820663",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391820663",
            "telephone_number": "601-738-5549",
            "fax_number": "601-630-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MCAULEY DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832825",
            "telephone_number": "601-738-5549",
            "fax_number": "601-630-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-22",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-738-5549",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.