Heber Clark Ethridge Jr., MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

08726 Issued in MS

Practice address

1151 N State St
Suite 311
Jackson, MS 39202

Phone

(601) 969-1171

Fax

(601) 969-1173

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Pain Center PA

  • Pain Medicine (Anesthesiology) Physician
  • Jackson, MS
  • NPI 1962823344
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289520000000",
    "number": "1881749489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 N STATE ST",
            "address_2": "SUITE 311",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022407",
            "telephone_number": "601-969-1171",
            "fax_number": "601-969-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 N STATE ST",
            "address_2": "SUITE 311",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39202",
            "telephone_number": "601-969-1171",
            "fax_number": "601-969-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "HEBER",
        "middle_name": "CLARK",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "08726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00011327",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zerelda Esquer Garrigos, M.D.
• Angela Marie Essary, MS, LPC
• Cody Estep, MD
• Timothy Duncan Estes, M.D.
• Chris Phillip Ethridge, MD
• Jesse C Ethridge, MD
• Austin Eubanks, LMSW
• Haleigh Bernice Eubanks, D.O., PH.D.
• Charles E. Evans III, D.O.
• Christopher Charles Evans, OD

• All providers in Jackson, MS
• Anesthesiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.