ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1326646845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1326646845 |
Entity Type | Organization |
Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
Practice Address |
106 Highland Way Ste 203 Madison MS 39110-6933 |
Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
Practice Telephone | 6012005000 |
Practice Fax Number | 6012004475 |
Mailing Telephone | 6012005000 |
Mailing Fax Number | 6012004475 |
Enumeration Date | 2020-10-16 |
Last Update Date | 2020-10-16 |
Authorized Official Name | DANIELLE STUART (CREDENTIALING SPECIALIST) |
Authorized Official Telephone | 6012004880 |
Is Organization Subpart | Y |
Parent Organization Name | ST. DOMINIC-JACKSON MEMORIAL HOSPITAL |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
St. Dominic Dermatology | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
1093032849 | St Dominic Medical Associates LLC | Family Medicine | 969 Lakeland Dr St Thomas Hall, Jackson, MS 39216-4606 | 2010-05-03 |
1356732481 | St Dominic Medical Associates LLC | Internal Medicine | 971 Lakeland Dr, Suite, Jackson, MS 39216-4643 | 2015-02-11 |
1689063067 | St Dominic Medical Associates LLC | Urology | 971 Lakeland Dr, Suite 360, Jackson, MS 39216-4643 | 2015-01-22 |
1508263179 | St Dominic Medical Associates LLC | Nurse Practitioner | 890 Lakeland Dr, Jackson, MS 39216-4644 | 2014-11-26 |
1083032171 | St Dominic Medical Associates LLC | Family Medicine | 342 Magnolia Dr, Raleigh, MS 39153-6012 | 2014-04-04 |
1316361686 | St Dominic Medical Associates LLC | Surgery | 106 Highland Way, Ste 200, Madison, MS 39110-6929 | 2014-02-07 |
1215350152 | St Dominic Medical Associates LLC | Psychiatry & Neurology | 971 Lakeland Dr, Suite 557, Jackson, MS 39216-4643 | 2014-01-29 |
1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
1285987578 | St Dominic Medical Associates LLC | Hospitalist | 969 Lakeland Dr, Jackson, MS 39216 | 2012-10-24 |
Street Address |
106 HIGHLAND WAY STE 203 |
City | MADISON |
State | MS |
Zip Code | 39110-6933 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649481607 | Jason K Taylor | Specialist | 106 Highland Way Ste 203, Madison, MS 39110-6933 | 2007-05-24 |
1528431145 | Kelli Conwill Cranford | Nurse Practitioner | 106 Highland Way Ste 203, Madison, MS 39110-6933 | 2015-11-04 |
1043449598 | Seth Alan Compton | Internal Medicine | 106 Highland Way Ste 203, Madison, MS 39110-6933 | 2009-07-06 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
Find all providers in zip 39110 |
Taxonomy Code | 207N00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043851249 | Pure Skin Dermatology & Oncology, Inc | Dermatology | 12205 County Line Rd Ste D, Madison, AL 35758-7720 | 2019-09-30 |
1194248013 | Kyle Erick Rudningen | Dermatology | Uw Hosptials & Clinics 600 Highland Ave, Madison, WI 53792 | 2017-07-23 |
1689028029 | Katelyn Zimmer | Dermatology | 8331 Madison Blvd Ste 300, Madison, AL 35758-2073 | 2016-04-22 |
1285912402 | Thomas D Keenan | Dermatology | 1 S Park St, 7th Floor, Department of Dermatology,university of Wisconsin, Madison, WI 53715-0001 | 2011-07-22 |
1063689727 | Rachel I Kornik | Dermatology | Uw Health Dept of Dermatology 1 S. Park St, Administrative Office 7th Floor, Madison, WI 53715 | 2008-05-13 |
1548471071 | Joya Sahu | Dermatology | 44 Hughes Rd Ste 100, Madison, AL 35758-3045 | 2007-05-25 |
1972656650 | Yaohui Gloria Xu | Dermatology | 1 S. Park Street, 7th Floor, Madison, WI 53715 | 2007-01-18 |
1699736991 | Anne E Rosin | Dermatology | 2009 Madison St, Madison, WI 53711-2129 | 2006-03-28 |
1497724629 | Rita Lloyd | Dermatology | 1316 Morrison St, Madison, WI 53703-3812 | 2006-03-17 |
1629040886 | Donald Richard Greene | Dermatology | 80 Randi Dr, Madison, CT 06443-2462 | 2006-02-02 |
Find all providers in MADISON |
Please comment or provide details below to improve the information on ST DOMINIC MEDICAL ASSOCIATES LLC.
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.