Vicksburg Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VICKSBURG CLINIC LLC

Practice address

2100 Highway 61 N
Vicksburg, MS 39183-8211

Phone

(601) 883-5000

NPI assigned

Jul 17, 2006

Last updated

Jun 9, 2008By 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

Debbie T Brewer

Title

Director of Provider Enrollment

Phone

(877) 892-9813

Specialties & licenses 9

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• River Region Health System

  • Pulmonary Disease Physician
  • Vicksburg, MS
  • NPI 1679508683

  O20040116000738

  Same enrollment
• Vicksburg Clinic LLC

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1659307791

  O20040116000738

  Same enrollment
• Vicksburg Clinic LLC

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1790711158

  O20040116000738

  Same enrollment

Practitioners 2

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.

• Deborah Smith, MD

  • Pediatrics Physician
  • Vicksburg, MS
  • NPI 1841228087
  NPD
• Thomas L Weeks, MD

  • Obstetrics & Gynecology Physician
  • Vicksburg, MS
  • NPI 1760427090
  NPD

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1992722482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1444618",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015545",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015548",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00720204",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vicksburg Clinic LLC (One Medical Plaza - RHC)
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC
• Vicksburg Clinic LLC (River Region Rural Health - MOB1)
• Vicksburg Clinic LLC (River Region Rural Health - SC)
• Vicksburg Community Center
• Vicksburg Convalescent, LLC (Vicksburg Convalescent Center)
• Vicksburg Emergency Physicians LLP
• Vicksburg Family Dental
• Vicksburg Family Dental 61N

• Family Medicine Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.