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ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1124452859


NPI Information

NPI: 1124452859
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: ST DOMINIC PAIN MANAGEMENT CENTER

Classification: Pain Medicine - 208VP0014X
Entity Type: Organization

Specialization: Interventional Pain Medicine

CLIA Number: 25D2089641

Address:
970 LAKELAND DR
SUITE 45
JACKSON, MS
ZIP 39216
Phone: (601) 200-4690
Get Directions

ST DOMINIC MEDICAL ASSOCIATES LLC is an interventional pain medicine pain medicine in Jackson, MS. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. ST DOMINIC MEDICAL ASSOCIATES LLC NPI is 1124452859. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Dominic Pain Management Center.

The provider's business location address is:

970 LAKELAND DR
SUITE 45
JACKSON, MS
ZIP 39216-635
Phone: (601) 200-4690
Fax: (601) 200-4698

The provider's authorized official is Jennifer Sinclair .
The authorized official title is President Of Sdma and has the following contact phone number (601) 200-2000.

The CLIA number assigned to this NPI record is 25D2089641 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/29/2013 and was last updated on 2/4/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208VP0014XPain MedicineInterventional Pain MedicineMISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
108009242MEDICAIDMISSISSIPPI
2302G700675MEDICARE PINMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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