MISSISSIPPI CHILDRENS HEART CLINIC PLLC (NPI# 1366042236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366042236 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CHILDRENS HEART CLINIC PLLC |
| Practice Address |
1190 N State St Ste 200 Jackson MS 39202-2413 |
| Mailing Address |
Po Box 22646 Jackson MS 39225-2646 |
| Practice Telephone | 6019656100 |
| Mailing Telephone | 6019441717 |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | STEPHANIE PURVIS (OFFICE MANAGER) |
| Authorized Official Telephone | 6019656100 |
| Authorized Official Credential | OFFICE MANAGER |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| MS Children's Heart | Doing Business As Name - Organization |
| Street Address |
1190 N STATE ST STE 200 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356602379 | Newborn Associates Pa | Pediatrics | 1190 N State St, Suite 200, Jackson, MS 39202-2413 | 2012-06-06 |
| 1003172248 | Michael David Weiland Jr. | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2012-04-02 |
| 1447578455 | Jarrod Dow Knudson | Pediatrics | 2500 North State Street, Jackson, MS 39216-4500 | 2010-05-14 |
| 1437309028 | Frank Abrokwah Osei | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2008-09-19 |
| 1376705699 | Scott A. Simpson | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2008-06-27 |
| 1982803524 | Khyati Pandya | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2007-07-13 |
| 1316154974 | Avichal Aggarwal | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2007-05-16 |
| 1932252798 | Upa Pllc Div Cardiology | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2007-01-18 |
| 1568493450 | Jennifer C Shores | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2006-07-06 |
| 1922030659 | Charles H Gaymes | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2006-07-06 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on MISSISSIPPI CHILDRENS HEART CLINIC PLLC.
| 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.