institution
Physician Practice Of Madison, Pc
Specialist in Vicksburg, Mississippi
NPI 1114476389

Physician Practice Of Madison, Pc is a Specialist based in Madison, MS. Physician Practice Of Madison, Pc practices in Vicksburg, MS. The NPI Number for Physician Practice Of Madison, Pc is 1114476389 and holds a License No. 21500 (Mississippi).

The current practice location address for Physician Practice Of Madison, Pc is 1111 N Frontage Rd Fl 2, Vicksburg, MS and can be reached out via phone at 412-721-2417 and via fax at 601-510-2367. You can also correspond with Physician Practice Of Madison, Pc through the mailing address at 6 EASTBROOKE CIR, MADISON, MS - 39110-6537 (mailing address contact number: 412-721-2417).

Location: 1111 N Frontage Rd Fl 2, Vicksburg, MS, 39110-6537
institution
Provider Profile Details
NPI Number
1114476389
Provider Name
Physician Practice Of Madison, Pc
Credential
Provider Entity Type
Organization
Address
1111 N Frontage Rd Fl 2, Vicksburg, MS, 39110-6537
Phone Number
412-721-2417
Fax Number
601-510-2367
Provider Enumeration Date
09/28/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
04377714 05 MS
351416 01 MS MEDICARE PTAN
institution
Provider Business Practice Location Address Details
Address
1111 N Frontage Rd Fl 2
City
State
Zip
39180-5102
Phone Number
412-721-2417
Fax Number
601-510-2367
person
Provider Business Mailing Address Details
Address
1111 N Frontage Rd Fl 2
City
State
Zip
39180-5102
Phone Number
412-721-2417
Fax Number
601-510-2367
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
License No.
21500 (Mississippi)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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