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ST DOMINIC MEDICAL ASSOCIATES NPI 1346510559


NPI Information

NPI: 1346510559
Provider Name: ST DOMINIC MEDICAL ASSOCIATES

Doing Business As: ST DOMINIC'S GYNECOLOGIC ONCOLOGY

Classification: Obstetrics & Gynecology - 207VX0201X
Entity Type: Organization

Specialization: Gynecologic Oncology

CLIA Number: 25D1022336

Address:
971 LAKELAND DR
SUITE 750
JACKSON, MS
ZIP 39216
Phone: (601) 200-4970
Get Directions

ST DOMINIC MEDICAL ASSOCIATES is a gynecologic oncology obstetrics gynecology in Jackson, MS. The provider is an obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. ST DOMINIC MEDICAL ASSOCIATES NPI is 1346510559. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Dominic's Gynecologic Oncology.

The provider's business location address is:

971 LAKELAND DR
SUITE 750
JACKSON, MS
ZIP 39216-643
Phone: (601) 200-4970
Fax: (601) 200-5943

The provider's authorized official is Danielle Stuart .
The authorized official title is Credentialing Specialist and has the following contact phone number (601) 200-4880.

The CLIA number assigned to this NPI record is 25D1022336 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/4/2012 and was last updated on 3/16/2021.


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
1207VX0201XObstetrics & GynecologyGynecologic OncologyYes

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
101652268MEDICAIDMISSISSIPPI

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

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