# ST DOMINIC MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST DOMINIC JACKSON MEMORIAL HOSPITAL
- **Other names:** CHRONIC CARE CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093032849
- **Legal business name:** ST DOMINIC JACKSON MEMORIAL HOSPITAL
- **Authorized official:** JENNIFER SINCLAIR (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (601) 200-2000

## Contact information

- **Practice address:** 969 LAKELAND DR ST THOMAS HALL, JACKSON, MS 39216-4606
- **Practice address phone:** (601) 200-3110
- **Practice address fax:** (601) 200-3109
- **Mailing address:** PO BOX 23666, JACKSON, MS 39225-3666
- **Mailing address phone:** (601) 200-4749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2010
- **Last updated:** 12/20/2013