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ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1831342054


NPI Information

NPI: 1831342054
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: CARDIOVASCULAR SURGERY ASSOCIATES

Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Organization

CLIA Number: 25D2009509

Address:
970 LAKELAND DR STE 61
JACKSON, MS
ZIP 39216
Phone: (601) 200-2780
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ST DOMINIC MEDICAL ASSOCIATES LLC is a thoracic surgery cardiothoracic vascular surgery in Jackson, MS. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. ST DOMINIC MEDICAL ASSOCIATES LLC NPI is 1831342054. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Cardiovascular Surgery Associates.

The provider's business location address is:

970 LAKELAND DR STE 61
JACKSON, MS
ZIP 39216-634
Phone: (601) 200-2780
Fax: (601) 200-2788

The provider's authorized official is Danielle Stuart .
The authorized official title is Credentialing Representative 2 and has the following contact phone number (601) 200-4880.

The CLIA number assigned to this NPI record is 25D2009509 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/31/2008 and was last updated on 6/16/2021.


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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)Yes

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
100978789MEDICAIDMISSISSIPPI

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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