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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.

Location: 1111 N Frontage Rd Fl 2, Vicksburg, MS, 39110-6537
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
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
Vicksburg
State
Mississippi
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
Vicksburg
State
Mississippi
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
174400000X
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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