Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST. DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
Cardiovascular Surgery Associates
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
970 LAKELAND DR STE 61, JACKSON, MS 39216-4634
(601) 200-2780
(601) 200-2788
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-2780
(601) 200-2788
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00978789
—
MS
Enumeration date
10/31/2008
Last updated
06/16/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us