NPIMap

Organization Active NPI

University of Mississippi Medical Center

  • Counseling Psychologist
  • Jackson, MS
National Provider Identifier
1043549280
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
49850 Issued in MS
Legal business name
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
2500 N State St # H819-01
Jackson, MS 39216-4500
Phone
(601) 984-5957
NPI assigned
Dec 17, 2009
Last updated
Oct 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Authorized official

Name
Keith Gran
Title
Ceo for University Physician
Phone
(601) 815-4775

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 22061 CA
Counseling Psychologist 103TC1900X 49850 MS Primary

Addresses

Primary practice location

2500 N State St # H819-01
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5957

Other names 1

  • UMMC Other name

National Provider Directory

National Provider Directory
Tax ID family
University of Mississippi Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2500 N State St
#H81901
Jackson, MS 39216
Phone (601) 984-5957

Interoperability endpoints

  • FHIR API: https://soapproxy.umc.edu/FHIRProxy/api/FHIR/R4/

NPI Registry JSON

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1043549280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST # H819-01",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "GRAN",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO FOR UNIVERSITY PHYSICIAN",
        "authorized_official_telephone_number": "601-815-4775"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "22061",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MS",
            "license": "49850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMMC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 25, 2010; 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.