Provider Demographics
NPI:1659319796
Name:VICKSBURG HEALTHCARE LLC
Entity Type:Organization
Organization Name:VICKSBURG HEALTHCARE LLC
Other - Org Name:RIVER REGION HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:DEPT 03-006
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39181-1198
Mailing Address - Country:US
Mailing Address - Phone:601-883-5157
Mailing Address - Fax:601-883-5197
Practice Address - Street 1:2100 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-8211
Practice Address - Country:US
Practice Address - Phone:601-883-5157
Practice Address - Fax:601-883-5197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICKSBURG HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-02
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
25T031Medicare Oscar/Certification