JACKSON VA MEDICAL CENTER (NPI# 1285716928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285716928 |
| Entity Type | Organization |
| Organization Name | JACKSON VA MEDICAL CENTER |
| Practice Address |
1500 E Woodrow Wilson Ave Jackson MS 39216-5116 |
| Practice Telephone | 6013624471 |
| Practice Fax Number | 6013641298 |
| Mailing Telephone | 6013624471 |
| Mailing Fax Number | 6013641298 |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. RICHARD J BALTZ (CENTER DIRECTOR) |
| Authorized Official Telephone | 6013641359 |
| Authorized Official Credential | D.O |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
1500 E WOODROW WILSON AVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-5116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740264035 | Sadeka Tamanna | Internal Medicine | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2005-12-01 |
| 1881291383 | Regina Marie Riley | Recreation Therapist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-10-07 |
| 1811502024 | Wendy Hopkins | Registered Nurse | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-09-14 |
| 1528679420 | Christopher Michael Mcguffey | Physical Therapist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-08-13 |
| 1124637319 | Kathryn Martin Lewis | Registered Nurse | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-07-24 |
| 1932727468 | Davis Mckenna Simms | Recreation Therapist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-07-10 |
| 1154948222 | Tiffany Floyd | Recreation Therapist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-07-06 |
| 1962029389 | Devonda Y Elliott | Recreation Therapist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-07-01 |
| 1629693759 | Latorya Lashay Smith | Dietitian, Registered | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-06-15 |
| 1932721669 | Aubrey Cain Young | Pharmacist | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2020-05-15 |
| 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 | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720694193 | Detox West Tennessee LLC | Substance Abuse Rehabilitation Facility | 370 N Cumberland St, Jackson, TN 38301-5470 | 2020-09-21 |
| 1215550736 | Cataldie Publishing LLC | Substance Abuse Rehabilitation Facility | 349 Highway 61, Jackson, LA 70748-4218 | 2020-05-19 |
| 1013543982 | New Life Recovery, LLC | Substance Abuse Rehabilitation Facility | 14761 State Route 93 Unit 4, Jackson, OH 45640-9820 | 2020-03-23 |
| 1750885703 | W. A. Foote Memorial Hospital, Inc | Substance Abuse Rehabilitation Facility | 2424 W Washington Ave Ste 200, Jackson, MI 49203-1236 | 2018-03-22 |
| 1518206440 | Alcohol Services Center, Inc. | Substance Abuse Rehabilitation Facility | 950 N West St, Jackson, MS 39202-2566 | 2013-02-13 |
| 1669603593 | Harbor Houses of Jackson, Inc. | Substance Abuse Rehabilitation Facility | 5354 I 55 S, Jackson, MS 39272-9119 | 2009-07-27 |
| 1629232384 | T.a.m.b. of Jackson Tn Inc | Substance Abuse Rehabilitation Facility | 110 Mccowat St, Jackson, TN 38301-5279 | 2008-07-11 |
| 1083766323 | Jackson Area Council On Alcoholism and Drug Dependency | Substance Abuse Rehabilitation Facility | 900 E Chester St, Jackson, TN 38301-6502 | 2007-01-17 |
| 1669641197 | Ashley House, Inc. | Substance Abuse Rehabilitation Facility | 308 W Ashley St, Jackson, MN 56143-1568 | 2008-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619585809 | Oxford Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 616 Commerce Parkway, Oxford, MS 38655 | 2020-07-14 |
| 1861047250 | Defining Wellness Centers Inc. | Substance Abuse Rehabilitation Facility | 630 Lakeland East Dr Ste A, Flowood, MS 39232-9565 | 2019-08-03 |
| 1093284598 | Safe Harbor Recovery and Counseling LLC | Substance Abuse Rehabilitation Facility | 123 Westover Dr, Hattisburg, MS 39402-1329 | 2018-11-14 |
| 1164948196 | Extra Mile Recovery | Substance Abuse Rehabilitation Facility | 720 Oak Grove Rd, Mantachie, MS 38855-8469 | 2017-08-22 |
| 1891149738 | Stonewater Addiction Recovery Center | Substance Abuse Rehabilitation Facility | 38 County Road 362, Oxford, MS 38655-8514 | 2016-04-18 |
| 1386042471 | Recovery House, Inc. | Substance Abuse Rehabilitation Facility | 770 Golding Road, Columbus, MS 39704-2590 | 2014-12-05 |
| 1487067237 | Addiction Campuses of Mississippi, LLC | Substance Abuse Rehabilitation Facility | 7185 Swinnea Rd, Southaven, MS 38671-6003 | 2014-06-10 |
| 1023373586 | Clever Recovery | Substance Abuse Rehabilitation Facility | 185 Foxtrail Rd, Picayune, MS 39466-9027 | 2012-07-11 |
| 1760610109 | Frontline Recovery, LLC | Substance Abuse Rehabilitation Facility | 1038 River Ridge Rd, Summit, MS 39666-9715 | 2009-06-24 |
| 1376701573 | The Oxford Centre, LLC | Substance Abuse Rehabilitation Facility | 297 County Road 244, Etta, MS 38627-9523 | 2008-05-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JACKSON VA MEDICAL CENTER.
| 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.