Provider Demographics
NPI:1114008901
Name:VICKSBURG WOMEN'S CARE, INC
Entity Type:Organization
Organization Name:VICKSBURG WOMEN'S CARE, INC
Other - Org Name:VICKSBURG WOMENS' CARE, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-883-2900
Mailing Address - Street 1:100 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-4476
Mailing Address - Country:US
Mailing Address - Phone:601-883-2900
Mailing Address - Fax:
Practice Address - Street 1:100 MAXWELL DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-4476
Practice Address - Country:US
Practice Address - Phone:601-883-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3144Medicare ID - Type Unspecified