ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (NPI# 1003979386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003979386 |
| Entity Type | Organization |
| Organization Name | ST. DOMINIC-JACKSON MEMORIAL HOSPITAL |
| Practice Address |
969 Lakeland Dr Jackson MS 39216-4606 |
| Practice Telephone | 6012006000 |
| Practice Fax Number | 6013215170 |
| Mailing Telephone | 6012006000 |
| Mailing Fax Number | 6013215170 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. MARY HELEN BOWEN (ASST. VICE PRESIDENT PHARMACY SERV.) |
| Authorized Official Telephone | 6012006010 |
| Authorized Official Credential | R.PH. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
0101003.1 | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BLUE CROSS | 20034 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST. DOMINIC-JACKSON MEMORIAL HOSPITAL | 969 Lakeland Dr, Jackson, MS 39216-4606 |
| Street Address |
969 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306843131 | Joseph N Candelora | Pathology | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2005-07-07 |
| 1316554736 | Brooke Collins | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-29 | |
| 1972117232 | William Paul Coe | Nurse Practitioner | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-03 |
| 1376157099 | Kathryn Taylor Parvin | Radiology | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-09-01 |
| 1235741646 | Stephanie H Atkins | Student in an Organized Health Care Education/Training Program | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-08-18 |
| 1063038636 | Ayanna Washington | Registered Nurse | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-06-19 |
| 1669092227 | Christopher L Stephens | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-04-23 |
| 1578190385 | Lindsey Elizabeth Jibol | Counselor | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-03-24 |
| 1801436951 | Callie Bridges | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
| 1053951194 | Zachary Halliwell | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 3336I0012X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Institutional Pharmacy |
| A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1689165482 | Georgia Diagnostic & Classification Prison Pharmacy | Pharmacy | 2978 Highway 36 W, Jackson, GA 30233-6150 | 2018-05-29 |
| 1962999789 | State Veterans Affairs Board | Pharmacy | 4607 Lindbergh Dr, Jackson, MS 39209-3855 | 2018-04-17 |
| 1811039704 | Jackson-madison County General Hospital | Pharmacy | 708 W Forest Ave, Jackson, TN 38301-3901 | 2007-02-14 |
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| 1104998269 | Pharmakan, Inc | Pharmacy | 1042a River Oaks Dr, Flowood, MS 39232-9594 | 2006-11-14 |
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| 1740202571 | Boswell Regional Center | Pharmacy | 1049 Hwy 149, Magee, MS 39111 | 2006-07-24 |
| 1023549060 | Brentwood Acquisition Pharmacy | Pharmacy | 3531 Lakeland Dr, Flowood, MS 39232-8049 | 2017-03-22 |
| 1285177394 | Formulaone Pharmaceuticals, LLC | Pharmacy | 127 Pratt Dr, Corinth, MS 38834-6026 | 2016-11-21 |
| 1578989430 | King's Daughters Hospital Pharmacy | Pharmacy | 823 Grand Ave, Yazoo City, MS 39194-3233 | 2014-03-14 |
| 1841623808 | George County Pharmacy | Pharmacy | 92 Ratliff St, Lucedale, MS 39452-6537 | 2013-08-14 |
| 1487787347 | Alliance Health Center Pharmacy | Pharmacy | 5000 Highway 39 N, Meridian, MS 39301-1021 | 2007-03-13 |
| 1619000593 | Diamond Grove Center | Pharmacy | 2311 Highway 15 S, Louisville, MS 39339-7071 | 2007-03-13 |
| 1194850917 | North Mississippi State Hospital Pharmacy | Pharmacy | 1937 Briar Ridge Rd, Tupelo, MS 38804-5963 | 2007-02-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.