Vicksburg Special Care Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VICKSBURG SPECIAL CARE CLINIC LLC

Practice address

4077 Pemberton Square Blvd
Vicksburg, MS 39180-5580

Phone

(601) 638-8600

Fax

(601) 638-8661

NPI assigned

Sep 29, 2009

Organization subpart

No

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

Authorized official

Name

Mitchell Chad Barrett

Title

Owner/Member

Phone

(601) 529-9341

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

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

• Sandra F. Burford, M.D.

  • Health Maintenance Organization
  • Vicksburg, MS
  • NPI 1912217308
  NPD (past)
• Christina R Hossley, NP

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1770863631
  NPD (past)
• Kerrie Sanders- Smith

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1144695669
  NPD (past)

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1487988002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805580",
            "telephone_number": "601-638-8600",
            "fax_number": "601-638-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805580",
            "telephone_number": "601-638-8600",
            "fax_number": "601-638-8661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG SPECIAL CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "601-529-9341"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01483541",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01123325",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vicksburg Midwifery Inc
• Vicksburg Nephrology LLC
• Vicksburg Orthodontics LLC
• Vicksburg Pathology Laboratory
• Vicksburg Primary Care Team Inc
• Vicksburg Special Care Pharmacy and Compounding LLC
• Vicksburg Spine Center, LLC
• Vicksburg Surgical Associates, PA
• Vicksburg Warren School District
• Vicksburg Women'S Care, Inc

• All providers in Vicksburg, MS
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; 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.