MAE PHYSICIANS SURGERY CENTER, LLC (NPI# 1033190129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033190129 |
| Entity Type | Organization |
| Organization Name | MAE PHYSICIANS SURGERY CENTER, LLC |
| Practice Address |
1190 N State St Ste 102 Jackson MS 39202-2413 |
| Mailing Address |
Po Box 12673 Jackson MS 39236-2673 |
| Practice Telephone | 6019681790 |
| Practice Fax Number | 6012924531 |
| Mailing Telephone | 6019681790 |
| Mailing Fax Number | 6012924531 |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2014-04-10 |
| Authorized Official Name | MRS. CARLA GLAZE (ADMINISTRATOR) |
| Authorized Official Telephone | 6019681790 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
1190 N STATE ST STE 102 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881699775 | Richard L Blount | Ophthalmology | 1190 N State St, Ste 403, Jackson, MS 39202-2413 | 2005-06-16 |
| 1871086207 | Sarah Kelly Erwin | Dietitian, Registered | 1190 N State St, Jackson, MS 39202-2413 | 2018-06-11 |
| 1184081234 | Tammy Sims Davis | Physician Assistant | 1190 N State St, Suite 502, Jackson, MS 39202-2413 | 2016-01-20 |
| 1720453145 | Jarrod Bryant | Physical Therapist | 1190 N State St, Jackson, MS 39202-2413 | 2015-12-10 |
| 1750756201 | Mississippi Baptist Health Systems | Physical Therapist | 1190 N State St, Jackson, MS 39202-2413 | 2015-12-09 |
| 1164897807 | Benjamin Adcock | Physical Therapist | 1190 N State St, Jackson, MS 39202-2413 | 2015-12-07 |
| 1275903684 | Brian Gates | Nurse Practitioner | 1190 N State St, Suite 300, Jackson, MS 39202-2413 | 2015-09-28 |
| 1376940130 | Joel Christopher Boothe | Registered Nurse | 1190 N State St, Suite 301, Jackson, MS 39202-2413 | 2014-11-21 |
| 1134546294 | Tammy Bartholomew | Social Worker | 1190 N State St, Suite 301, Jackson, MS 39202-2413 | 2014-03-26 |
| 1366866154 | Courtney Wright | Physician Assistant | 1190 N State St, Suite 502, Jackson, MS 39202-2413 | 2014-02-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
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| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821336371 | Eyecare Surgery Center, LLC | Clinic/Center | 1501 Lakeland Dr Ste 101, Jackson, MS 39216-4839 | 2013-01-17 |
| 1265618904 | Jackson Gastroenterology Center, LLC | Clinic/Center | 4400 Ann Arbor Road, Jackson, MI 49202 | 2008-01-11 |
| 1912099805 | Sapheneia Medical Minimally Invasive Therapy Institute | Clinic/Center | 932 N State St, Jackson, MS 39202-2613 | 2006-09-28 |
| 1588764989 | W. A. Foote Memorial Hospital, Inc. | Clinic/Center | 1125 E Michigan Ave, Jackson, MI 49201-1801 | 2006-09-25 |
| 1225096498 | Amador Surgery Center | Clinic/Center | 223 Clinton Road, Suite 204, Jackson, CA 95642-2680 | 2006-05-03 |
| 1558327213 | Surgicare of Jackson Ltd | Clinic/Center | 760 Lakeland Dr, Jackson, MS 39216-4610 | 2006-04-21 |
| 1588631832 | Surgical Services of Michigan, LLC | Clinic/Center | 2775 Blake Road, Jackson, MI 49201-8838 | 2006-03-07 |
| 1255303517 | St Dominic Ambulatory Surgery Center L L C | Clinic/Center | 970 Lakeland Dr, Suite 15, Jackson, MS 39216-4601 | 2006-02-02 |
| 1689651481 | Teton Outpatient Services LLC | Clinic/Center | 150 Buffalo Way, Jackson, WY 83001-2530 | 2005-12-22 |
| 1710591060 | Midsouth Interventional Pain Institute LLC | Clinic/Center | 2016 Greystone Sq, Jackson, TN 38305-3575 | 2020-09-03 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.