NPIMap

Organization Active NPI

St. Dominic Medical Associates, LLC

  • Neurology Physician
  • Jackson, MS
National Provider Identifier
1083989412
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES, LLC
Practice address
969 Lakeland Dr
Jackson, MS 39216-4606
Phone
(601) 200-4749
Fax
(601) 200-5929
NPI assigned
Mar 19, 2012
Organization subpart
Yes
Parent organization
ST. DOMINIC JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

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

Authorized official

Name
Jennifer Sinclair
Title
VP of Finance
Phone
(601) 200-4749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

969 Lakeland Dr
Jackson, MS 39216-4606

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

National Provider Directory

National Provider Directory
Tax ID family
St Dominic Medical Associates LLC28 organizations share this tax ID, including this one
Part of
Chemical Dependency Uni

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1083989412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "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": "601-200-4749",
            "fax_number": "601-200-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. DOMINIC JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "601-200-4749"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Mar 19, 2012; 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.