JACKSON VAMC (NPI# 1376598698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376598698 |
| Entity Type | Organization |
| Organization Name | JACKSON VAMC |
| Other Organization Name | HATTIESBURG VA CLINIC |
| Practice Address |
5003 Hardy Street Tower B Suite 402 Hattiesburg MS 39402-1331 |
| Mailing Address |
Po Box 94497 Cleveland OH 44101-4497 |
| Practice Telephone | 6153553451 |
| Mailing Telephone | 6153553451 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2017-10-04 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Hattiesburg VA Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
| 1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
| 1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
| 1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
| 1154784965 | Jackson Vamc | Psychiatric Residential Treatment Facility | 1500 Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2016-03-30 |
| 1922496280 | Jackson Vamc | Clinic/Center | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2015-01-08 |
| 1467762120 | Jackson Vamc | Clinic/Center | 1308 Harrison Ave, Mccomb, MS 39648-2830 | 2010-10-15 |
| 1992754543 | Jackson Vamc | General Acute Care Hospital | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2006-05-10 |
| Street Address |
5003 HARDY STREET TOWER B SUITE 402 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402-1331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
| 1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
| 1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
| 1073552436 | Memphis Vamc | Clinic/Center | 1114 Commonwealth Blvd., Tupelo, MS 38804-9998 | 2006-06-04 |
| 1194778357 | Memphis Vamc | Clinic/Center | 1700 Crescent Meadows, Holly Springs, MS 38635-7414 | 2006-05-18 |
| 1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
| 1972044048 | Dewona Flowers | Clinic/Center | 604 Lexington Cv, Byram, MS 39272-3004 | 2017-03-09 |
| 1245770445 | Clinton Medical Center | Clinic/Center | 604 Lexington Cv, Byram, MS 39272-3004 | 2017-03-07 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39402 |
Please comment or provide details below to improve the information on JACKSON VAMC.
| 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.