NPIMap

Organization Active NPI

Vicksburg Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Vicksburg, MS
National Provider Identifier
1154532257
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
VICKSBURG CLINIC LLC
Practice address
1115 N Frontage Rd
Vicksburg, MS 39180-5102
Phone
(601) 634-8790
NPI assigned
May 24, 2007
Last updated
Apr 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie T Brewer
Title
VP
Phone
(877) 892-9813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1115 N Frontage Rd
Vicksburg, MS 39180-5102

Mailing address

1115 N Frontage Rd
Vicksburg, MS 39180-5102
Phone (601) 634-8790

National Provider Directory

National Provider Directory
Tax ID family
Vicksburg Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1154532257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 N FRONTAGE RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805102",
            "telephone_number": "601-634-8790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 N FRONTAGE RD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805102",
            "telephone_number": "601-634-8790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "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 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.