Organization
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL THADDEUS SCOTT (CFO)
(601) 200-6570
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6000
(601) 321-5170
Mailing address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6000
(601) 321-5170
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
0101003.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000020034
—
MS
01
—
20034
BLUE CROSS
MS
Enumeration date
12/18/2006
Last updated
05/13/2024
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