Vicksburg Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

VICKSBURG CLINIC LLC

Practice address

3317 Pemberton Square Blvd
Vicksburg, MS 39180-5578

Phone

(601) 636-1173

Fax

(601) 630-9674

NPI assigned

Sep 15, 2025

Organization subpart

Yes

Parent organization

VICKSBURG CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Kristy Music

Title

Director Provider Enrollment / Ao

Phone

(615) 465-7377

Specialties & licenses 1

Addresses

Other names 1

• Merit Health Medical Group Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Vicksburg Clinic6 organizations share this tax ID, including this one

Part of

Vicksburg Clinic

Other organizations with this tax ID 5

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

• Vicksburg Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Vicksburg, MS
  • NPI 1154532257
  NPD tax ID
• Vicksburg Clinic LLC

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1619355203
  NPD tax ID
• Vicksburg Clinic LLC

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1790915395
  NPD tax ID
• Vicksburg Clinic LLC

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1861622268
  NPD tax ID
• Vicksburg Clinic LLC

  • Surgery Physician
  • Vidalia, LA
  • NPI 1629279054
  NPD tax ID

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

{
    "created_epoch": "1757894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1174494975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7429",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805578",
            "telephone_number": "601-636-1173",
            "fax_number": "601-630-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VICKSBURG CLINIC LLC",
        "enumeration_date": "2025-09-15",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "MUSIC",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT / AO",
        "authorized_official_telephone_number": "615-465-7377"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Merit Health Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Vicksburg Allergy and Asthma
• Vicksburg Cardiology PLLC
• Vicksburg Center for Exceptional Children
• Vicksburg City Office of the City Clerk
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC

• All providers in Vicksburg, MS
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.