Organization
ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER G. KOURY CPA, FHFMA (EXECUTIVE VICE PRESIDENT)
(601) 200-6950
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
(600) 200-0924
Mailing address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
(600) 200-0924
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
14-031
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00020034
—
MS
Enumeration date
07/26/2006
Last updated
08/22/2020
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