NPIMap

Organization Active NPI

Vanderloo Family Medicine, PLLC

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1235768755
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VANDERLOO FAMILY MEDICINE, PLLC
Practice address
3000 Old Canton Rd Ste 240
Jackson, MS 39216-4235
Phone
(601) 228-5491
Fax
(601) 429-9297
NPI assigned
Apr 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Authorized official

Name
John P.F.H. Vanderloo, MDNPI 1336451624
Title
Owner
Phone
(601) 228-5491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3000 Old Canton Rd Ste 240
Jackson, MS 39216-4235

Mailing address

3000 Old Canton Rd Ste 240
Jackson, MS 39216-4235
Phone (601) 228-5491

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1235768755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 240",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164235",
            "telephone_number": "601-228-5491",
            "fax_number": "601-429-9297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 240",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164235",
            "telephone_number": "601-228-5491",
            "fax_number": "601-429-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERLOO FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "VANDERLOO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P.F.H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-228-5491",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "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 Apr 6, 2020; 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.