SAPHENEIA MEDICAL MINIMALLY INVASIVE THERAPY INSTITUTE (NPI# 1912099805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912099805 |
| Entity Type | Organization |
| Organization Name | SAPHENEIA MEDICAL MINIMALLY INVASIVE THERAPY INSTITUTE |
| Practice Address |
932 N State St Jackson MS 39202-2613 |
| Practice Telephone | 6013525663 |
| Practice Fax Number | 6013524437 |
| Mailing Telephone | 6013525663 |
| Mailing Fax Number | 6013524437 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RICHARD A MANCILLA (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 6013525663 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
932 N STATE ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2613 |
| 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 | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821336371 | Eyecare Surgery Center, LLC | Clinic/Center | 1501 Lakeland Dr Ste 101, Jackson, MS 39216-4839 | 2013-01-17 |
| 1265618904 | Jackson Gastroenterology Center, LLC | Clinic/Center | 4400 Ann Arbor Road, Jackson, MI 49202 | 2008-01-11 |
| 1588764989 | W. A. Foote Memorial Hospital, Inc. | Clinic/Center | 1125 E Michigan Ave, Jackson, MI 49201-1801 | 2006-09-25 |
| 1225096498 | Amador Surgery Center | Clinic/Center | 223 Clinton Road, Suite 204, Jackson, CA 95642-2680 | 2006-05-03 |
| 1558327213 | Surgicare of Jackson Ltd | Clinic/Center | 760 Lakeland Dr, Jackson, MS 39216-4610 | 2006-04-21 |
| 1588631832 | Surgical Services of Michigan, LLC | Clinic/Center | 2775 Blake Road, Jackson, MI 49201-8838 | 2006-03-07 |
| 1255303517 | St Dominic Ambulatory Surgery Center L L C | Clinic/Center | 970 Lakeland Dr, Suite 15, Jackson, MS 39216-4601 | 2006-02-02 |
| 1689651481 | Teton Outpatient Services LLC | Clinic/Center | 150 Buffalo Way, Jackson, WY 83001-2530 | 2005-12-22 |
| 1710591060 | Midsouth Interventional Pain Institute LLC | Clinic/Center | 2016 Greystone Sq, Jackson, TN 38305-3575 | 2020-09-03 |
| 1386149979 | W. A. Foote Memorial Hospital, Inc | Clinic/Center | 205 S East Ave, Jackson, MI 49201-2413 | 2018-03-27 |
| 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.