ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1174757017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174757017 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | EAR NOSE AND THROAT SURGICAL GROUP |
| Practice Address |
970 Lakeland Dr Suite 40 Jackson MS 39216-4635 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012004850 |
| Practice Fax Number | 6012004838 |
| Mailing Telephone | 6012004749 |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2013-12-18 |
| Authorized Official Name | MS. JENNIFER SINCLAIR (VICE PRESIDENT OF FINANCE) |
| Authorized Official Telephone | 6012002000 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST DOMINIC JACKSON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Ear Nose and Throat Surgical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
| 1093032849 | St Dominic Medical Associates LLC | Family Medicine | 969 Lakeland Dr St Thomas Hall, Jackson, MS 39216-4606 | 2010-05-03 |
| 1326646845 | St Dominic Medical Associates LLC | Dermatology | 106 Highland Way Ste 203, Madison, MS 39110-6933 | 2020-10-16 |
| 1356732481 | St Dominic Medical Associates LLC | Internal Medicine | 971 Lakeland Dr, Suite, Jackson, MS 39216-4643 | 2015-02-11 |
| 1689063067 | St Dominic Medical Associates LLC | Urology | 971 Lakeland Dr, Suite 360, Jackson, MS 39216-4643 | 2015-01-22 |
| 1508263179 | St Dominic Medical Associates LLC | Nurse Practitioner | 890 Lakeland Dr, Jackson, MS 39216-4644 | 2014-11-26 |
| 1083032171 | St Dominic Medical Associates LLC | Family Medicine | 342 Magnolia Dr, Raleigh, MS 39153-6012 | 2014-04-04 |
| 1316361686 | St Dominic Medical Associates LLC | Surgery | 106 Highland Way, Ste 200, Madison, MS 39110-6929 | 2014-02-07 |
| 1215350152 | St Dominic Medical Associates LLC | Psychiatry & Neurology | 971 Lakeland Dr, Suite 557, Jackson, MS 39216-4643 | 2014-01-29 |
| 1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
| Street Address |
970 LAKELAND DR SUITE 40 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255303517 | St Dominic Ambulatory Surgery Center L L C | Clinic/Center | 970 Lakeland Dr, Suite 15, Jackson, MS 39216-4601 | 2006-02-02 |
| 1326689662 | Jessica M Tolar | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2019-10-07 |
| 1861810889 | Radiation Oncology Associates of Mississippi | Radiology | 970 Lakeland Dr, Suite 34, Jackson, MS 39216-4635 | 2014-04-07 |
| 1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
| 1780988949 | Holly M Bridges | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2011-01-03 |
| 1023249497 | Lynn Ann Vincent | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2009-08-04 |
| 1578793220 | Valerie C Bailey | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2009-07-15 |
| 1578720231 | Angela Sterling | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2008-05-20 |
| 1144491580 | Magnolia Woman's Clinic, P.a. | Obstetrics & Gynecology | 970 Lakeland Dr, Suite 43, Jackson, MS 39216-4635 | 2008-03-13 |
| 1811198005 | Philip Lamar Chustz | Internal Medicine | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2007-05-29 |
| 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 | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1194973941 | Howard B Cheek | Otolaryngology | 4080 Boxwood Circle, Jackson, MS 39211-6609 | 2008-09-05 |
| 1881712057 | Ear Nose & Throat Surgical Group | Otolaryngology | 764 Lakeland Drive, Suite 200, Jackson, MS 39216-4617 | 2007-03-27 |
| 1811076938 | Kyle Ford Gordon | Otolaryngology | 970 Lakeland Dr Ste 40, Jackson, MS 39216-4640 | 2006-11-02 |
| 1285713305 | Andrew Byron Brown IIi | Otolaryngology | 764 Lakeland Dr Ste 200, Jackson, MS 39216-4617 | 2006-11-02 |
| 1780771956 | Tammy Sanders | Otolaryngology | 1500 E. Woodrow Wilson Ave., Jackson, MS 39216-5199 | 2006-10-06 |
| 1922097492 | Stephen L Kirkner | Otolaryngology | 1111 Teneyck St, Suite 100, Jackson, MI 49201-2461 | 2005-10-18 |
| 1720070535 | West Tennessee Ent Clinic, P.a. | Otolaryngology | 619 Skyline Dr, Jackson, TN 38301-3903 | 2005-08-17 |
| 1245795400 | Dr. Patricia A Murphy Pllc | Otolaryngology | 221 Highway 15 S, Jackson, KY 41339-9600 | 2019-02-01 |
| 1336677624 | Wendy Nicole Marino | Otolaryngology | 764 Lakeland Dr, Jackson, MS 39216-4651 | 2017-05-31 |
| Find all providers in JACKSON | ||||
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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.