UPA PLLC ADOLESCENT MED NPI 1205953809

NPI Information

NPI: 1205953809
Provider Name: UPA PLLC ADOLESCENT MED
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 984-5236
Get Directions

UPA PLLC ADOLESCENT MED is an adolescent medicine pediatrics in Jackson, MS. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. UPA PLLC ADOLESCENT MED NPI is 1205953809. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 984-5236

The provider's authorized official is Owen B Evans .
The authorized official title is Managing Employee and has the following contact phone number (601) 984-5214.

The enumeration date for this NPI number is 3/26/2007 and was last updated on 6/24/2008.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C02166	MEDICARE ID-TYPE UNSPECIFIED	MISSISSIPPI	MS MEDICARE GROUP NUMBER
2	09015331	MEDICAID	MISSISSIPPI

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: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »