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Organization
ST. DOMINIC MEDICAL ASSOCIATES LLC
Active
Organization
ST. DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST DOMINC JACKSON MEMORIAL HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST DOMINC JACKSON MEMORIAL HOSPITAL
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4749
(601) 200-5929
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207T00000X
Neurological Surgery Physician
—
NULL
207T00000X
Neurological Surgery Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
NULL
207VX0201X
Gynecologic Oncology Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2086S0102X
Surgical Critical Care Physician
—
NULL
2086S0102X
Surgical Critical Care Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
11/20/2006
Last updated
11/18/2021
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