Active NPI
St. Dominic-Jackson Memorial Hospital
- Institutional Pharmacy
- Jackson, MS
National Provider Identifier
1003979386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Institutional Pharmacy
- License
- 0101003.1
- Legal business name
- ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
- Practice address
- 969 Lakeland Dr
Jackson, MS 39216-4606 - Phone
- (601) 200-6000
- Fax
- (601) 321-5170
- NPI assigned
- Dec 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel Thaddeus Scott
- Title
- Cfo
- Phone
- (601) 200-6570
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Institutional Pharmacy | 3336I0012X | 0101003.1 | MS | Primary |
Addresses
Primary practice location
969 Lakeland Dr
Jackson, MS 39216-4606
Mailing address
969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-6000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20034 | Other | MS | BLUE CROSS |
| 000020034 | Medicaid | MS |
National Provider Directory
National Provider Directory- Tax ID family
- Chemical Dependency Uni
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1306876065
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715558400000",
"number": "1003979386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "969 LAKELAND DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164606",
"telephone_number": "601-200-6000",
"fax_number": "601-321-5170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "969 LAKELAND DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164606",
"telephone_number": "601-200-6000",
"fax_number": "601-321-5170"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. DOMINIC-JACKSON MEMORIAL HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-18",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A",
"authorized_official_last_name": "SCOTT",
"authorized_official_first_name": "SAMUEL",
"authorized_official_middle_name": "THADDEUS",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "601-200-6570"
},
"taxonomies": [
{
"code": "3336I0012X",
"taxonomy_group": "",
"desc": "Pharmacy, Institutional Pharmacy",
"state": "MS",
"license": "0101003.1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "20034",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000020034",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.