ST DOMINIC AMBULATORY SURGERY CENTER L L C (NPI# 1255303517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255303517 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC AMBULATORY SURGERY CENTER L L C |
| Practice Address |
970 Lakeland Dr Suite 15 Jackson MS 39216-4601 |
| Mailing Address |
970 Lakeland Dr. Suite 15 Jakcson MS 39216 |
| Practice Telephone | 6019848800 |
| Practice Fax Number | 6013218670 |
| Mailing Telephone | 6019848800 |
| Mailing Fax Number | 6013218670 |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2010-06-16 |
| Authorized Official Name | DR. RICHARD YELVERTON (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6019848800 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
011 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0770362 | 05 |
| Street Address |
970 LAKELAND DR SUITE 15 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326689662 | Jessica M Tolar | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2019-10-07 |
| 1861810889 | Radiation Oncology Associates of Mississippi | Radiology | 970 Lakeland Dr, Suite 34, Jackson, MS 39216-4635 | 2014-04-07 |
| 1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
| 1780988949 | Holly M Bridges | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2011-01-03 |
| 1023249497 | Lynn Ann Vincent | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2009-08-04 |
| 1578793220 | Valerie C Bailey | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2009-07-15 |
| 1174757017 | St Dominic Medical Associates LLC | Otolaryngology | 970 Lakeland Dr, Suite 40, Jackson, MS 39216-4635 | 2009-05-06 |
| 1578720231 | Angela Sterling | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2008-05-20 |
| 1144491580 | Magnolia Woman's Clinic, P.a. | Obstetrics & Gynecology | 970 Lakeland Dr, Suite 43, Jackson, MS 39216-4635 | 2008-03-13 |
| 1811198005 | Philip Lamar Chustz | Internal Medicine | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2007-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| 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 |
| 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 |
| 1386149979 | W. A. Foote Memorial Hospital, Inc | Clinic/Center | 205 S East Ave, Jackson, MI 49201-2413 | 2018-03-27 |
| 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.