NPIMap

Organization Active NPI

State of Mississippi - University of Mississippi Medical Center

  • Orthopaedic Surgery Physician
  • Jackson, MS
National Provider Identifier
1013563527
Registry record updated Aug 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
1410 E Woodrow Wilson Ave Ste I
Jackson, MS 39216-5114
Phone
(601) 984-6525
NPI assigned
Aug 12, 2019
Last updated
Aug 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Grimsley
Title
Cfo
Phone
(601) 496-9801

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

1410 E Woodrow Wilson Ave Ste I
Jackson, MS 39216-5114

Mailing address

2500 N. State Street
Cbo - Suite 4200
Jackson, MS 39216-4500
Phone (601) 496-9794

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565568000000",
    "number": "1013563527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N. STATE STREET",
            "address_2": "CBO - SUITE 4200",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-496-9794",
            "fax_number": "601-815-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 E WOODROW WILSON AVE STE I",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165114",
            "telephone_number": "601-984-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A",
        "authorized_official_last_name": "GRIMSLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-496-9801"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.