VICKSBURG CLINIC LLC NPI 1831308816

NPI Information

  • NPI: 1831308816
  • Provider Name: VICKSBURG CLINIC LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 10 CROTHERS DR
    STE. 4
    TALLULAH, LA
    ZIP 71282
  • Phone: (318) 574-0056

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NPI Details

VICKSBURG CLINIC LLC is a family medicine in Tallulah, LA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. VICKSBURG CLINIC LLC NPI is 1831308816. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10 CROTHERS DR
STE. 4
TALLULAH, LA
ZIP 71282-510
Phone: (318) 574-0056

The provider's authorized official is Debbie T Brewer .
The authorized official title is Director Of Provider Enrollment and has the following contact phone number (877) 892-9813.

The enumeration date for this NPI number is 5/22/2007 and was last updated on 10/1/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineNo
2208600000XSurgeryNo
3208800000XUrologyNo
4208D00000XGeneral PracticeNo
5207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11192694MEDICAIDLOUISIANA
21444740MEDICAIDLOUISIANA
35C933MEDICARE PINLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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