Vicksburg Holistic Healthcare, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VICKSBURG HOLISTIC HEALTHCARE, LLC

Practice address

919 Mission 66
Vicksburg, MS 39183-2751

Phone

(601) 642-5513

NPI assigned

Apr 14, 2016

Last updated

Apr 18, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary StrongNPI 1114173796

Title

Family Nurse Practitioner/ Owner

Phone

(601) 613-1398

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13530/brand/1/csg/1/fhir/r4

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Carter Strong, RN, MSN, FNP-BC

  • Family Nurse Practitioner
  • Flowood, MS
  • NPI 1114173796
  Medicare reassignment NPD Authorized official
• Michelle Banks, NP

  • Nurse Practitioner
  • Vicksburg, MS
  • NPI 1811932064
  Medicare reassignment NPD
• Gwendolyn Corrothers Royal, FNP-C

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1174298293
  Medicare reassignment NPD
• Lameka Q Miller, FNP

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1720631161
  Medicare reassignment NPD
• Barbara J Phelps

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1205932134
  Medicare reassignment NPD
• Gloria J Butler, MD

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1750312963
  NPD
• Liat Bearden, D.C.

  • Chiropractor
  • Laupahoehoe, HI
  • NPI 1548409832
  NPD (past)

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1568816643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820289",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391820289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832751",
            "telephone_number": "601-642-5513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG HOLISTIC HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "STRONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER/ OWNER",
        "authorized_official_telephone_number": "601-613-1398"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicksburg Healthcare LLC (River Region Health System)
• Vicksburg Healthcare LLC (River Region Health System)
• Vicksburg Healthcare LLC (Merit Health River Region West)
• Vicksburg Hma Physician Management LLC
• Vicksburg Hma Physician MGMT (Medical Associates of Vicksburg)
• Vicksburg Medical Teams MHT LLC
• Vicksburg Midwifery Inc
• Vicksburg Nephrology LLC
• Vicksburg Orthodontics LLC
• Vicksburg Pathology Laboratory

• Primary Care Clinic/Center in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.