Provider Demographics
NPI:1013233857
Name:VIBHA VIG MD PA
Entity Type:Organization
Organization Name:VIBHA VIG MD PA
Other - Org Name:SUNSHINE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-855-5287
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0626
Mailing Address - Country:US
Mailing Address - Phone:601-855-5287
Mailing Address - Fax:601-855-5130
Practice Address - Street 1:110 N JERRY CLOWER BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-8669
Practice Address - Country:US
Practice Address - Phone:601-855-5287
Practice Address - Fax:601-855-5130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13655261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care