ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1215350152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1215350152 |
Entity Type | Organization |
Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
Other Organization Name | ST DOMINIC NEUROSCIENCE CENTER |
Practice Address |
971 Lakeland Dr Suite 557 Jackson MS 39216-4643 |
Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
Practice Telephone | 6012004560 |
Practice Fax Number | 6012004850 |
Mailing Telephone | 6012004560 |
Mailing Fax Number | 6012004580 |
Enumeration Date | 2014-01-29 |
Last Update Date | 2019-10-28 |
Authorized Official Name | DANIELLE STUART (CREDENTIALING SPECIALIST) |
Authorized Official Telephone | 6012004880 |
Is Organization Subpart | Y |
Parent Organization Name | ST DOMINIC JACKSON MEMORIAL HOSPITAL |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
21151 | MS | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | 07430597 | 05 |
Other Name | Type Code |
---|---|
St Dominic Neuroscience Center | Doing Business As Name - Organization |
Address | Telephone Number | Fax Number |
---|---|---|
360 Simpson Highway 149 Ste 370, Magee, MS 391113843 | 6012004560 | 6012004580 |
4204 Clay St, Vicksburg, MS 391833438 | 6012004560 | 6012004580 |
332 Highway 12 W, Kosciusko, MS 390903209 | 6012004560 | 6012004580 |
810 E Sunflower Rd Ste 100j, Cleveland, MS 387322828 | 6012004560 | 6012004580 |
1014 Big Lane Dr, Brookhaven, MS 396012331 | 6012004560 | 6012004580 |
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 |
1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
1285987578 | St Dominic Medical Associates LLC | Hospitalist | 969 Lakeland Dr, Jackson, MS 39216 | 2012-10-24 |
Street Address |
971 LAKELAND DR SUITE 557 |
City | JACKSON |
State | MS |
Zip Code | 39216-4643 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588661789 | Maurice James | Ophthalmology | 971 Lakeland Dr, Ste 563, Jackson, MS 39216-4607 | 2005-07-01 |
1891226643 | Matthew Milling | Nurse Anesthetist, Certified Registered | 971 Lakeland Dr, Suite 202, Jackson, MS 39216-4643 | 2017-03-23 |
1134667843 | Bonney Neill Simmons | Nurse Practitioner | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2017-02-02 |
1437694320 | Kristen Degelman | Nurse Practitioner | 971 Lakeland Dr, Suite 401, Jackson, MS 39216-4643 | 2016-12-30 |
1134671787 | Jackson Thyroid & Endocrine Clinic Pllc | Internal Medicine | 971 Lakeland Dr, Suite 353, Jackson, MS 39216-4643 | 2016-10-31 |
1609223205 | Sally Sullivan | Nurse Anesthetist, Certified Registered | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2016-05-24 |
1932576998 | Misty Gaines | Nurse Practitioner | 971 Lakeland Dr, Suite 657, Jackson, MS 39216-4643 | 2015-08-26 |
1659755676 | Angela B. Mccallum | Nurse Practitioner | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2015-07-20 |
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 |
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 | 2084N0400X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Neurology |
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235454059 | Mitchell Myers, M.d. | Psychiatry & Neurology | 2906 North State Street, Suite 301, Jackson, MS 39216 | 2010-04-05 |
1477745842 | Catherine Haynes Wuthrich | Psychiatry & Neurology | 2092 Lilac Lane, Jackson, WY 83002 | 2007-08-09 |
1003907460 | Patrick E Weldon | Psychiatry & Neurology | 1860 Chadwick Drive, Suite 258, Jackson, MS 39204 | 2006-09-28 |
1801991401 | James H Spruill Jr. | Psychiatry & Neurology | 614 Skyline Dr, Jackson, TN 38301-3923 | 2006-09-14 |
1174628903 | Michael W Brueggeman | Psychiatry & Neurology | 700 West Forest, Ste 200, Jackson, TN 38301 | 2006-09-14 |
1417962952 | Mohamad R Karami-sichani | Psychiatry & Neurology | 50 Bent Creek Ln, Jackson, TN 38305-2170 | 2006-07-31 |
1760427496 | Sumathira T Sathanandan | Psychiatry & Neurology | 700 West Forest, Ste. 200, Jackson, TN 38301 | 2006-06-17 |
1174574701 | Kathleen A. Messenger | Psychiatry & Neurology | 971 Lakeland Dr Ste 557, Jackson, MS 39216-4661 | 2006-05-16 |
1669430708 | Aida Bodour | Psychiatry & Neurology | 1400 E Michigan Ave, Jackson, MI 49202-3518 | 2006-05-01 |
1891751806 | Umesh Verma | Psychiatry & Neurology | 1418 E Michigan Ave, Jackson, MI 49202-3518 | 2006-04-26 |
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.