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ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1083032171


NPI Information

NPI: 1083032171
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: ST DOMINIC RALEIGH FAMILY PRACTICE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 25D2077095

Address:
342 MAGNOLIA DR
RALEIGH, MS
ZIP 39153
Phone: (601) 200-6809
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ST DOMINIC MEDICAL ASSOCIATES LLC is a family medicine in Raleigh, MS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ST DOMINIC MEDICAL ASSOCIATES LLC NPI is 1083032171. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Dominic Raleigh Family Practice.

The provider's business location address is:

342 MAGNOLIA DR
RALEIGH, MS
ZIP 39153-012
Phone: (601) 200-6809
Fax: (601) 200-5929

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 25D2077095 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2014 and was last updated on 7/2/2019.


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
1207Q00000XFamily Medicine16442MISSISSIPPIYes

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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