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Contact Information

VICKSBURG NEPHROLOGY LLC
1202 MISSION PARK DRIVE
VICKSBURG, MS39180
 Phone: 601-738-5549
 Fax: 601-630-9120
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nephrology

207RN0300X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for VICKSBURG NEPHROLOGY LLC

NPI # 1013337658
LBN Legal business name VICKSBURG NEPHROLOGY LLC
Authorized official MICHAEL DAVIS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/22/2014
Last updated 04/22/2014 - About 12 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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