Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
St Dominic Urology
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Authorized official
JENNIFER SINCLAIR (PRESIDENT OF SDMA)
(601) 200-6955
Entity
Organization
Contact information
Practice address
971 LAKELAND DR, SUITE 360, JACKSON, MS 39216-4643
(601) 200-4370
(601) 200-4375
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
09524
MS
208800000X
Urology Physician
11495
MS
208800000X
Urology Physician
Primary
13524
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06782543
—
MS
Enumeration date
01/22/2015
Last updated
06/17/2016
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