MR. ANTHONY BRADLEY BOLAND (NPI# 1437135373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1437135373 |
Entity Type | Individual |
Full Name | MR. ANTHONY BRADLEY BOLAND |
Credential | M.D. |
Practice Address |
2500 N State St Jackson MS 39216-4500 |
Practice Telephone | 6019842680 |
Practice Fax Number | 6018154563 |
Mailing Telephone | 6019842680 |
Mailing Fax Number | 6018154563 |
Enumeration Date | 2005-12-22 |
Last Update Date | 2014-12-03 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
20979 | MS | Allopathic & Osteopathic Physicians |
N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD00022869 | WA | Allopathic & Osteopathic Physicians |
N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
044417 | GA | Allopathic & Osteopathic Physicians |
N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD29549 | TN | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | PHP TENNCARE | 100033107 | 01 |
TN | UNITED HEALTHCARE | 3740047 | 01 |
GA | 00832917B | 05 | |
TN | BLUECROSS OF TN | 3153656 | 01 |
AETNA | 4078780 | 01 | |
MS | RAILROAD MEDICARE PTAN | P01189946 | 01 |
TN | CIGNA HMO | 0140040322 | 01 |
TN | JOHN DEERE HEALTHCARE | 62178953301 | 01 |
AL | 009965915 | 05 | |
FIRST HEALTH | 56812 | 01 | |
WA | 8490567 | 05 | |
MS | 07188733 | 05 | |
TN | 3812941 | 05 |
Street Address |
2500 N STATE ST |
City | JACKSON |
State | MS |
Zip Code | 39216-4500 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477556231 | University Ophthalmology Associates | Ophthalmology | 2500 N State St, Ste B329, Jackson, MS 39216-4500 | 2005-05-24 |
1396346607 | Ashleigh Renfroe Hannah | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-11-03 |
1770182438 | Tara P. Carter | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-10-22 |
1679189849 | Raegan Wilson | Registered Nurse | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-22 |
1851905095 | Violet Maloba Awori | Student in an Organized Health Care Education/Training Program | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-04 |
1295348639 | Kassidy Voinche | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-25 |
1215549423 | Brittney Leeann Williams | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-19 |
1912519364 | Rashmi Verma | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-18 |
1982215414 | Anita Dhanrajani | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-10 |
1528676954 | Nicholas Mcafee | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2020-07-22 |
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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 |
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Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952557092 | Medical Foundation of Central Mississippi, Inc | Surgery | 501 Marshall St Ste 100, Jackson, MS 39202-1687 | 2008-08-08 |
1174556377 | Seshadri Raju, M.d., Pa. | Surgery | 971 Lakeland Dr Ste 401, Jackson, MS 39216 | 2006-07-09 |
1225575186 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
1124565098 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
1275893638 | Derek Paul De Grijs | Surgery | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2012-05-20 |
1184911612 | Taimur Saleem | Surgery | 971 Lakeland Dr Ste 401, Jackson, MS 39216-4607 | 2011-07-05 |
1245545383 | Danon Eugenio Garrido Montes De Oca | Surgery | 2500 N State St, Jackson, MS 39216-4500 | 2010-08-12 |
1194825323 | Fred Wallace Rushton Jr. | Surgery | 2500 N State St, Jackson, MS 39216-4500 | 2006-09-25 |
1215960414 | Seshadri Raju | Surgery | 971 Lakeland Dr, Suite 401, Jackson, MS 39216-4643 | 2006-07-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104323534 | Best Vein Care of Mississippi, LLC | Surgery | 204 W Jackson St Ste A, Ridgeland, MS 39157-2310 | 2018-04-11 |
1457714172 | Flowood Medical Management LLC | Surgery | 4800 Lakeland Dr, Flowood, MS 39232-8694 | 2016-03-30 |
1982009031 | Magnolia General and Vascular Surgery Clinic | Surgery | 611 Alcorn Dr Ste 210, Corinth, MS 38834-9323 | 2014-10-31 |
1730406729 | Alexander H. Nguyen | Surgery | 4503 M St, Biloxi, MS 39530 | 2010-04-29 |
1730243064 | Frank A Nichols | Surgery | 1040 A So Madison, Tupelo, MS 38801 | 2006-12-21 |
1427073386 | Edward E Rigdon | Surgery | 348 Crossgates Blvd, Suite 2500, Brandon, MS 39042-2700 | 2006-07-13 |
1790760692 | Surgery Associates Pa | Surgery | 440 Pegram Dr, Tupelo, MS 38801-6319 | 2005-12-13 |
1396226791 | North Mississippi Medical Center, Inc | Surgery | 616 Alcorn Dr, Corinth, MS 38834-9393 | 2018-08-23 |
1962952689 | Capel Vascular Center, LLC | Surgery | 408 E Washington St, Greenwood, MS 38930-4539 | 2016-10-05 |
1104101575 | North Mississippi Medical Center Services, LLC | Surgery | 607 Garfield St, Tupelo, MS 38801-6337 | 2011-10-18 |
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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.