ST DOMINIC-JACKSON MEMORIAL HOSPITAL (NPI# 1306876065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306876065 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC-JACKSON MEMORIAL HOSPITAL |
| Practice Address |
969 Lakeland Dr Jackson MS 39216-4606 |
| Practice Telephone | 6012002000 |
| Practice Fax Number | 6012000924 |
| Mailing Telephone | 6012002000 |
| Mailing Fax Number | 6012000924 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. PETER G KOURY (EXECTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 6012006950 |
| Authorized Official Credential | CPA, FHFMA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 14-031 | MS | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00020034 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679596860 | St Dominic-jackson Memorial Hospital | Psychiatric Unit | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2006-07-26 |
| 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 | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093265159 | Missouri Delta Medical Center | General Acute Care Hospital | 2856 Vista Ridge Pl, Jackson, MO 63755-8105 | 2016-10-12 |
| 1679810022 | Proficiency Scribes Cs, LLC | General Acute Care Hospital | 114 Bradley Rd, Jackson, GA 30233-3702 | 2013-01-04 |
| 1073588034 | Carelink of Jackson, A Community-owned Specialty Hospital | General Acute Care Hospital | 110 N. Elm Avenue, Jackson, MI 49202-3595 | 2006-02-22 |
| 1760921894 | University of Mississippi Medical Center | General Acute Care Hospital | 764 Lakeland Dr, 2nd Floor, Jackson, MS 39216-4651 | 2017-02-22 |
| 1629475348 | Mallory Miller | General Acute Care Hospital | 620 Skyline Dr, Jackson, TN 38301-3923 | 2014-11-24 |
| 1861833535 | University Hospital | General Acute Care Hospital | 2500 N State St, Jackson, MS 39216-4500 | 2013-07-10 |
| 1730480120 | Mississippi Baptist Medical Center, Inc. | General Acute Care Hospital | 1225 N State St, Jackson, MS 39202-2064 | 2010-11-16 |
| 1497068639 | W.a. Foote Memorial Hospital | General Acute Care Hospital | 205 N East Ave, 7th Floor One Jackson Square, Jackson, MI 49201-1753 | 2010-07-16 |
| 1538472964 | The University of Mississippi Medical Center | General Acute Care Hospital | 2500 N State St, Jackson, MS 39216-4500 | 2010-07-14 |
| 1033349501 | University of Mississipi Medical Center | General Acute Care Hospital | 2500 N State St, Jackson, MS 39216-4500 | 2009-07-20 |
| 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.