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ST. DOMINIC JACKSON MEMORIAL NPI 1235173691


NPI Information

NPI: 1235173691
Provider Name: ST. DOMINIC JACKSON MEMORIAL

Former Legal Business Name: ST DOMINIC EMERGENCY ROOM

Classification: Emergency Medicine - 207P00000X
Entity Type: Organization
Address:
969 LAKELAND DR
JACKSON, MS
ZIP 39216
Phone: (601) 200-2000
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ST. DOMINIC JACKSON MEMORIAL is an emergency medicine in Jackson, MS. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. ST. DOMINIC JACKSON MEMORIAL NPI is 1235173691. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is St Dominic Emergency Room.

The provider's business location address is:

969 LAKELAND DR
JACKSON, MS
ZIP 39216-606
Phone: (601) 200-2000

The provider's authorized official is Karl Hatten .
The authorized official title is Director and has the following contact phone number (601) 200-2000.

The enumeration date for this NPI number is 6/16/2006 and was last updated on 8/11/2010.


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
1207L00000XAnesthesiologyMISSISSIPPINo
2208600000XSurgeryMISSISSIPPINo
3367H00000XAnesthesiologist AssistantMISSISSIPPINo
4367500000XNurse Anesthetist, Certified RegisteredMISSISSIPPINo
5207P00000XEmergency 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
109014778MEDICAIDMISSISSIPPI
2C02387MEDICARE 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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