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Contact Information

ST DOMINIC MEDICAL ASSOCIATES LLC
969 LAKELAND DR
JACKSON, MS39216
 Phone: 601-200-5900
 Fax: 601-200-0204
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hospitalist

208M00000X
Indicates primary specialty

NPI Profile & details for ST DOMINIC MEDICAL ASSOCIATES LLC · (Female)

NPI Number 1285987578
Status Active
Credentials
Entity Individual
Enumeration date 10/24/2012
Last updated 03/21/2022 - About 4 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS Medicaid 02055703
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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