Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
St. Dominic Hospital Medicine, St Dominic Pallative Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Authorized official
DANIELLE STUART (CREDENTIALING REPRESENTATIVE 2)
(601) 200-4880
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216
(601) 200-5900
(601) 200-0204
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4644
(601) 200-4645
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02055703
—
MS
Enumeration date
10/24/2012
Last updated
03/21/2022
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