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ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1689063067


NPI Information

NPI: 1689063067
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: ST DOMINIC UROLOGY

Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 25D2094318

Address:
971 LAKELAND DR
SUITE 360
JACKSON, MS
ZIP 39216
Phone: (601) 200-4370
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ST DOMINIC MEDICAL ASSOCIATES LLC is an urology in Jackson, MS. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. ST DOMINIC MEDICAL ASSOCIATES LLC NPI is 1689063067. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Dominic Urology.

The provider's business location address is:

971 LAKELAND DR
SUITE 360
JACKSON, MS
ZIP 39216-643
Phone: (601) 200-4370
Fax: (601) 200-4375

The provider's authorized official is Jennifer Sinclair .
The authorized official title is President Of Sdma and has the following contact phone number (601) 200-6955.

The CLIA number assigned to this NPI record is 25D2094318 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/22/2015 and was last updated on 6/17/2016.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrology09524MISSISSIPPINo
2208800000XUrology11495MISSISSIPPINo
3208800000XUrology13524MISSISSIPPIYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
106782543MEDICAIDMISSISSIPPI
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: 4/28/2024

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