Active NPI
Oral Pathology Services-Umc
- Dental Laboratory
- Jackson, MS
National Provider Identifier
1336320795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Laboratory
- Legal business name
- ORAL PATHOLOGY SERVICES-UMC
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-6194
- Fax
- (601) 815-3901
- NPI assigned
- Nov 14, 2007
- Organization subpart
- Yes
- Parent organization
- UNIVERSITY DENTISTS, PLLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stacy Brookerd
- Title
- Manager, Business Operations
- Phone
- (601) 984-6094
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Laboratory | 292200000X | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-6194
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09014021 | Medicaid | MS |
National Provider Directory
National Provider Directory- Part of
- University Dentists PLL
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1327536000000",
"number": "1336320795",
"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": "601-984-6194",
"fax_number": "601-815-3901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-6194",
"fax_number": "601-815-3901"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ORAL PATHOLOGY SERVICES-UMC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "UNIVERSITY DENTISTS, PLLC",
"enumeration_date": "2007-11-14",
"last_updated": "2012-01-26",
"status": "A",
"authorized_official_last_name": "BROOKERD",
"authorized_official_first_name": "STACY",
"authorized_official_title_or_position": "MANAGER, BUSINESS OPERATIONS",
"authorized_official_telephone_number": "601-984-6094"
},
"taxonomies": [
{
"code": "292200000X",
"taxonomy_group": "",
"desc": "Dental Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09014021",
"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 Jan 26, 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.