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ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1548698608


NPI Information

NPI: 1548698608
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: ST DOMINIC FAMILY PRACTICE BRANDON

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 25D2068935

Address:
1297 WEST GOVERNMENT STREET
BRANDON, MS
ZIP 39042
Phone: (601) 200-4790
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ST DOMINIC MEDICAL ASSOCIATES LLC is a family medicine in Brandon, 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 1548698608. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Dominic Family Practice Brandon.

The provider's business location address is:

1297 WEST GOVERNMENT STREET
BRANDON, MS
ZIP 39042
Phone: (601) 200-4790
Fax: (601) 200-4855

The provider's authorized official is Jennifer Sinclair .
The authorized official title is President Of Sdma and has the following contact phone number (601) 200-2000.

The CLIA number assigned to this NPI record is 25D2068935 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/28/2013 and was last updated on 12/30/2016.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine18818MISSISSIPPIYes

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
102751790MEDICAIDMISSISSIPPI
2302G700675MEDICARE PINMISSISSIPPI

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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