VANDERLOO FAMILY MEDICINE PLLC NPI 1235768755

NPI Information

  • NPI: 1235768755
  • Provider Name: VANDERLOO FAMILY MEDICINE, PLLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 25D2176486
  • Address: 3000 OLD CANTON RD STE 240
    JACKSON, MS
    ZIP 39216
  • Phone: (601) 228-5491

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NPI Details

VANDERLOO FAMILY MEDICINE, PLLC is a family medicine in Jackson, 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. VANDERLOO FAMILY MEDICINE, PLLC NPI is 1235768755. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3000 OLD CANTON RD STE 240
JACKSON, MS
ZIP 39216-235
Phone: (601) 228-5491
Fax: (601) 429-9297

The provider's authorized official is John P.f.h. Vanderloo .
The authorized official title is Owner and has the following contact phone number (601) 228-5491.

The CLIA number assigned to this NPI record is 25D2176486 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2020 and was last updated on 4/6/2020.

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
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 3/30/2025

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