G.V. Montgomery VA Medical Center

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

R897708 Issued in MS

Legal business name

G.V. MONTGOMERY VA MEDICAL CENTER

Practice address

1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116

Phone

(601) 368-4498

NPI assigned

Aug 22, 2014

Last updated

Aug 22, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Audrey D Youngblood, RN

Title

RN

Phone

(601) 320-8949

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1871992131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116",
            "telephone_number": "601-368-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116",
            "telephone_number": "601-368-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G.V. MONTGOMERY VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "YOUNGBLOOD",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "601-320-8949",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "R897708",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "P326213",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frazier Earl Fyke III, M.D.
• Kristen Tomlinson Fyke, M.D.
• G & N Enterprise, LLC
• G Eli Howell MD PLLC (Howell Plastic Surgery)
• G. V. Sonny Montgomery VA Medical Center
• G.V. Sonny Montgomery Medical Center
• Ricky L Gable, MD
• Jeanne Marisa Gabriele, PH.D.
• Dora Ann Gaddis
• Menarvia Nixon Gaddis, MD

• General Acute Care Hospital in Jackson, MS
• Providers in Jackson, MS by specialty
• General Acute Care Hospital in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.