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HEEERS PA NPI 1215933346


NPI Information

NPI: 1215933346
Provider Name: HEEERS, PA

Doing Business As: SULLIVAN FAMILY MEDICINE CLINIC

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 25D1011770

Address:
1814 HOSPITAL DR
JACKSON, MS
ZIP 39204
Phone: (601) 373-2940
Get Directions

HEEERS, PA is a clinic center in Jackson, MS. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). HEEERS, PA NPI is 1215933346. The provider is registered as an organization entity type.
The provider Is Doing Business As Sullivan Family Medicine Clinic.

The provider's business location address is:

1814 HOSPITAL DR
JACKSON, MS
ZIP 39204-410
Phone: (601) 373-2940
Fax: (601) 373-2720

The provider's authorized official is Hursie J Davis-sullivan .
The authorized official title is Owner And President and has the following contact phone number (601) 373-2940.

The CLIA number assigned to this NPI record is 25D1011770 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/23/2005 and was last updated on 11/9/2010.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/Center13888MISSISSIPPIYes

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
1C02914MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPI
200112110MEDICAIDMISSISSIPPI
308236531MEDICAIDMISSISSIPPI
4F65463MEDICARE UPINMISSISSIPPI
5080003184MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPIHURSIE DAVIS-SULLIVAN

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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