JACKSON VAMC (NPI# 1467762120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1467762120 |
Entity Type | Organization |
Organization Name | JACKSON VAMC |
Other Organization Name | MCCOMB VA CBOC |
Practice Address |
1308 Harrison Ave Mccomb MS 39648-2830 |
Mailing Address |
Po Box 94497 Cleveland OH 44101-4497 |
Practice Telephone | 6153553451 |
Mailing Telephone | 6153553451 |
Enumeration Date | 2010-10-15 |
Last Update Date | 2017-10-04 |
Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
Authorized Official Telephone | 2023822579 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
McComb VA CBOC | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
1376598698 | Jackson Vamc | Clinic/Center | 5003 Hardy Street, Tower B Suite 402, Hattiesburg, MS 39402-1331 | 2006-05-24 |
1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
1154784965 | Jackson Vamc | Psychiatric Residential Treatment Facility | 1500 Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2016-03-30 |
1922496280 | Jackson Vamc | Clinic/Center | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2015-01-08 |
1992754543 | Jackson Vamc | General Acute Care Hospital | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2006-05-10 |
Street Address |
1308 HARRISON AVE |
City | MCCOMB |
State | MS |
Zip Code | 39648-2830 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871505008 | Nileshkumar Kantilal Kothari | Internal Medicine | 1308 Harrison Ave, Mccomb, MS 39648-2830 | 2006-08-13 |
1013461433 | Rex Anne Leggett | Registered Nurse | 1308 Harrison Ave, Mccomb, MS 39648-2830 | 2016-08-15 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
1952910457 | Fresenius Medical Care East Mccomb Dialysis, LLC | Clinic/Center | 103 Business Center Drive, Mccomb, MS 39648 | 2020-07-30 |
1902423312 | Joseph Edward Mingo II | Counselor | 513 Lee St, Mccomb, MS 39648 | 2020-07-01 |
1427608769 | Benda Truvillion | Technician | 2128 Park Dr. Ext., Mccomb, MS 39648 | 2019-09-18 |
1295228187 | Edna Ruth Winston | Counselor | Sw Ms Mental Health Complex, 1701 White St, Mccomb, MS 39648 | 2018-06-14 |
1386153450 | Sholitha Nunnery | Counselor | 502 North Cherry Street, Mccomb, MS 39648 | 2017-09-21 |
1548600612 | Jordan Harrington | Nurse Practitioner | 303 Marion Ave., Mccomb, MS 39648 | 2013-07-03 |
1891096236 | Zwound Care | Family Medicine | 1126 Country Club Road, Mccomb, MS 39648 | 2010-11-16 |
1588891717 | Kelly Edmondson | Physical Therapy Assistant | 1301a Harrison Ave, Mccomb, MS 39648 | 2009-06-15 |
1962647651 | Gwendolyn Michelle Brown | Home Health Aide | 1114 1/2 Venable St., Mccomb, MS 39648 | 2008-12-09 |
Find all providers in zip 39648 |
Taxonomy Code | 261QV0200X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | VA |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
1073552436 | Memphis Vamc | Clinic/Center | 1114 Commonwealth Blvd., Tupelo, MS 38804-9998 | 2006-06-04 |
1376598698 | Jackson Vamc | Clinic/Center | 5003 Hardy Street, Tower B Suite 402, Hattiesburg, MS 39402-1331 | 2006-05-24 |
1194778357 | Memphis Vamc | Clinic/Center | 1700 Crescent Meadows, Holly Springs, MS 38635-7414 | 2006-05-18 |
1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
1972044048 | Dewona Flowers | Clinic/Center | 604 Lexington Cv, Byram, MS 39272-3004 | 2017-03-09 |
Find all providers with the same taxonomy |
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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.