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JACKSON ONCOLOGY ASSOCIATES PLLC NPI 1023147204


NPI Information

NPI: 1023147204
Provider Name: JACKSON ONCOLOGY ASSOCIATES, PLLC
Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 25D0673115

Address:
2200 HIGHWAY 61 N STE 3300
VICKSBURG, MS
ZIP 39183
Phone: (601) 638-3447
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JACKSON ONCOLOGY ASSOCIATES, PLLC is a hematology and oncology internal medicine in Vicksburg, MS. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. JACKSON ONCOLOGY ASSOCIATES, PLLC NPI is 1023147204. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2200 HIGHWAY 61 N STE 3300
VICKSBURG, MS
ZIP 39183-246
Phone: (601) 638-3447
Fax: (601) 630-9227

The provider's authorized official is Kim Ward .
The authorized official title is Chief Operations Officer and has the following contact phone number (601) 974-5513.

The CLIA number assigned to this NPI record is 25D0673115 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 11/9/2021.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RH0003XInternal MedicineHematology & 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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
103330910MEDICAIDMISSISSIPPI

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: 5/5/2024

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