PRENTISS PRIMARY CARE P.A. NPI 1902129455

NPI Information

  • NPI: 1902129455
  • Provider Name: PRENTISS PRIMARY CARE, P.A.
  • Classification: Internal Medicine - 207R00000X
  • Entity Type: Organization
  • CLIA Number: 25D1007211
  • Address: 959 HWY 42
    PRENTISS, MS
    ZIP 39474
  • Phone: (601) 792-3200

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NPI Details

PRENTISS PRIMARY CARE, P.A. is an internal medicine in Prentiss, MS. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PRENTISS PRIMARY CARE, P.A. NPI is 1902129455. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

959 HWY 42
PRENTISS, MS
ZIP 39474-373
Phone: (601) 792-3200
Fax: (601) 792-3299

The provider's authorized official is Jaishankar Jagadeesan .
The authorized official title is President and has the following contact phone number (601) 792-3200.

The CLIA number assigned to this NPI record is 25D1007211 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/11/2010 and was last updated on 3/11/2010.

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
1207R00000XInternal Medicine15442MISSISSIPPIYes

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
100118344MEDICAIDMISSISSIPPI
209016230MEDICAIDMISSISSIPPI

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: 11/21/2025

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