Vicksburg Clinic LLC
NPI 1629279054 · Surgery Physician · Vidalia, LA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Vicksburg Clinic LLC is a Surgery Physician organization in Vidalia, LA (NPI 1629279054).
Provider details
- NPI number
- 1629279054
- Entity type
- Organization
- Primary specialty
- Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kristy Music, Director Provider Enrollment(615) 465-7377
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
- Obstetrics & Gynecology Physician207V00000X
Allopathic & Osteopathic Physicians
- Urology Physician208800000X
Allopathic & Osteopathic Physicians
- General Practice Physician208D00000X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2007-05-31
- Last updated
- 2025-02-14
- Certified
- 2025-02-14
Frequently asked questions
- What is Vicksburg Clinic LLC's NPI number?
- Vicksburg Clinic LLC's National Provider Identifier (NPI) is 1629279054, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Vicksburg Clinic LLC?
- Vicksburg Clinic LLC is classified in the NPPES registry as Surgery Physician (Allopathic & Osteopathic Physicians).
- Where is Vicksburg Clinic LLC located?
- Vicksburg Clinic LLC's practice location on file with NPPES is 107 Front St Ste 1200, Vidalia, LA 71373-2834.
- What is Vicksburg Clinic LLC's phone number?
- The practice phone number listed in the NPPES registry for Vicksburg Clinic LLC is (318) 336-2220.
- Does Vicksburg Clinic LLC accept Medicare?
- Vicksburg Clinic LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Vicksburg Clinic LLC?
- The authorized official listed on Vicksburg Clinic LLC's NPPES record is Kristy Music, Director Provider Enrollment. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Vicksburg Clinic LLC's NPI active?
- Yes — Vicksburg Clinic LLC's NPI (1629279054) is active in the NPPES registry as of the last update on 2025-02-14.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.