Mississippi Center for Advanced Medicine, PC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC

Practice address

2053 Gause Blvd E Ste 200
Slidell, LA 70461-5451

Phone

(985) 259-8045

Fax

(601) 499-0311

NPI assigned

Mar 25, 2019

Organization subpart

Yes

Parent organization

MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PCAs reported in NPPES

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

Authorized official

Name

Spencer K Sullivan, MD

Title

Ceo/Owner

Phone

(601) 499-0935

Specialties & licenses 3

Addresses

Other names 1

• Louisiana Center for Advanced Medicine Doing business as

Part of

Mississippi Ctr for Adv Med

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1548720527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD STE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106115",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 GAUSE BLVD E STE 200",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615451",
            "telephone_number": "985-259-8045",
            "fax_number": "601-499-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "601-499-0935",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Louisiana Center for Advanced Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Louisiana Center for Advanced Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Milliet, M.S., PLPC
• Joshua Mills, MHS
• Mind and Body Care LLC
• Mind Changing Inc
• Mississippi Center for Advanced Medicine, PC
• Shelley Mitchell, RN
• Tara Mitchell, MD
• Taylor Mobley, MA, PLPC
• James Patrick Mollere, CRNA
• Monet Logistics

• Community/Retail Pharmacy in Slidell, LA
• Providers in Slidell, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.