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Contact Information

ST DOMINIC MEDICAL ASSOCIATES LLC
970 LAKELAND DR
SUITE 45
JACKSON, MS39216-4635
 Phone: 601-200-4690
 Fax: 601-200-4698
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

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

NPI # 1124452859
Status Active
Credentials
Entity Individual
Enumeration date 08/29/2013
Last updated 02/04/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS Medicaid 08009242
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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