MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC (NPI# 1790227627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790227627 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC |
| Practice Address |
7731 Old Canton Rd Suite B Madison MS 39110-6114 |
| Practice Telephone | 6014990935 |
| Practice Fax Number | 6014990936 |
| Mailing Telephone | 6014990935 |
| Mailing Fax Number | 6014990936 |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-12-21 |
| Authorized Official Name | DR. SPENCER K SULLIVAN (PRESIDENT/CEO) |
| Authorized Official Telephone | 6014990935 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 23304 | MS | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 01212067 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508426917 | Mississippi Center for Advanced Medicine, PC | Specialist | 2053 Gause Blvd E Ste 200, Slidell, LA 70461-5451 | 2019-06-18 |
| 1548720527 | Mississippi Center for Advanced Medicine, PC | Pharmacy | 2053 Gause Blvd E Ste 200, Slidell, LA 70461-5451 | 2019-03-25 |
| Street Address |
7731 OLD CANTON RD SUITE B |
| City | MADISON |
| State | MS |
| Zip Code | 39110-6114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578171013 | Nicole Maynor | Specialist | 1 Avenue C Ste 110, Madison, WV 25130-1100 | 2020-07-21 |
| 1043835440 | Michael Dale Shoultz | Specialist | 2622 Hoard St, Madison, WI 53704-4827 | 2020-06-11 |
| 1558713776 | David H. Morgan, M.d. | Specialist | 8371 Highway 72 W Ste 202, Madison, AL 35758-9505 | 2016-07-12 |
| 1104297274 | Andrea Renee Keapproth | Specialist | 433 W Washington Ave, Madison, WI 53703-3482 | 2015-10-14 |
| 1518209717 | Jessica Lee Boggs | Specialist | 7878 Big Sky Dr Ste H4, Madison, WI 53719-4984 | 2013-03-26 |
| 1740538305 | Amber J Thompson | Specialist | 8202 Excelisor Dr, Madison, WI 53717 | 2012-08-29 |
| 1194084939 | Linda Alanen | Specialist | 113 Quaker Cir, Madison, WI 53716-1643 | 2012-05-14 |
| 1538434782 | Deborah Ann Bachmann | Specialist | 2330 Willard Ave, Madison, WI 53704-5644 | 2012-03-20 |
| 1174843338 | Jonathan Morse | Specialist | 1901 Mckenna Blvd, #2, Madison, WI 53711-6318 | 2010-06-10 |
| 1386884849 | Susan A Rosa | Specialist | 3427 Viburnum Dr, Madison, WI 53705-1442 | 2009-02-24 |
| Find all providers in MADISON | ||||
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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.