Provider Demographics
NPI:1366504847
Name:VICKSBURG CITY OFFICE OF THE CITY CLERK
Entity Type:Organization
Organization Name:VICKSBURG CITY OFFICE OF THE CITY CLERK
Other - Org Name:VICKSBURG-WARREN COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR - CITY OF VICKSBURG
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-631-3717
Mailing Address - Street 1:1401 WALNUT ST
Mailing Address - Street 2:P.O. BOX 150
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3261
Mailing Address - Country:US
Mailing Address - Phone:601-619-7887
Mailing Address - Fax:601-634-4782
Practice Address - Street 1:1401 WALNUT ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3261
Practice Address - Country:US
Practice Address - Phone:601-619-7887
Practice Address - Fax:601-634-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00050052Medicaid
MS00050052Medicaid
MS302G598586Medicare PIN