DR. LIDGIA R VIVES-JACKSON (NPI# 1306922976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306922976 |
| Entity Type | Individual |
| Full Name | DR. LIDGIA R VIVES-JACKSON |
| Other Name | DR. LIDGIA R VIVES |
| Credential | M.D. |
| Practice Address |
1213 Broad Ave Ste 3 Gulfport MS 39501-2475 |
| Mailing Address |
8219 Persimmon Ln Long Beach MS 39560-9033 |
| Practice Telephone | 2288679797 |
| Practice Fax Number | 2288679788 |
| Mailing Telephone | 2288222000 |
| Mailing Fax Number | 2288222000 |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-09-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
15664 | MS | Allopathic & Osteopathic Physicians |
| Y | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
15664 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 05584384 | 05 |
| Street Address |
1213 BROAD AVE STE 3 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-2475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 2084V0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Vascular Neurology |
| Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
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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.