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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

NPI Number 1124452859
LBN Legal business name ST DOMINIC MEDICAL ASSOCIATES LLC
Authorized official JENNIFER SINCLAIR - (PRESIDENT OF SDMA)
Entity Organization
Organization subpart 1 Yes
Enumeration date 08/29/2013
Last updated 02/04/2015 - About 11 years ago
Identifiers
MS Medicaid 08009242
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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