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JACKSON NEUROSURGERY CLINIC PLLC NPI 1740364785


NPI Information

NPI: 1740364785
Provider Name: JACKSON NEUROSURGERY CLINIC, PLLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 25D1070828

Address:
1080 RIVER OAKS DR
SUITE B-103
FLOWOOD, MS
ZIP 39232
Phone: (601) 366-1011
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JACKSON NEUROSURGERY CLINIC, PLLC is a specialist in Flowood, MS. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. JACKSON NEUROSURGERY CLINIC, PLLC NPI is 1740364785. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1080 RIVER OAKS DR
SUITE B-103
FLOWOOD, MS
ZIP 39232-779
Phone: (601) 366-1011
Fax: (601) 932-6111

The provider's authorized official is Zoe Lewis .
The authorized official title is Practice Administrator and has the following contact phone number (601) 321-1504.

The CLIA number assigned to this NPI record is 25D1070828 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 10/28/2016.


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
1174400000XSpecialistMISSISSIPPIYes

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
108288260MEDICAIDMISSISSIPPI
2C03059OTHERMISSISSIPPIMEDICARE GROUP
35299460001MEDICARE NSCMISSISSIPPI
4CK4238OTHERMISSISSIPPIRAILROAD MEDICARE

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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