PREMIER MEDICAL GROUP OF MISSISSIPPI LLC (NPI# 1548219884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548219884 |
| Entity Type | Organization |
| Organization Name | PREMIER MEDICAL GROUP OF MISSISSIPPI LLC |
| Other Organization Name | JACKSON MEDICAL CLINIC LLC |
| Practice Address |
501 Marshall St Suite 208 Jackson MS 39202-1651 |
| Mailing Address |
Po Box 23996 Jackson MS 39225-3996 |
| Practice Telephone | 6013522273 |
| Practice Fax Number | 6013534414 |
| Mailing Telephone | 6012066113 |
| Mailing Fax Number | 6012066052 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2009-02-16 |
| Authorized Official Name | MR. JAMES C BETHEA (CEO) |
| Authorized Official Telephone | 6013522273 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | RAILROAD MEDICARE | CD1075 | 01 |
| MS | 09014760 | 05 |
| Other Name | Type Code |
|---|---|
| Jackson Medical Clinic LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790827038 | Premier Medical Group of Mississippi LLC | Clinic/Center | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2007-02-13 |
| Street Address |
501 MARSHALL ST SUITE 208 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-1651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932176641 | Sabra Sullivan | Dermatology | 501 Marshall St, Suite 606, Jackson, MS 39202-1651 | 2006-03-01 |
| 1598328684 | Caroline Douglass Peeples | Registered Nurse | 501 Marshall St, Jackson, MS 39202-1651 | 2019-04-15 |
| 1548655053 | Mississippi Urology Outpatient Surgery Center, LLC | Clinic/Center | 501 Marshall St, Suite 201, Jackson, MS 39202-1651 | 2015-04-01 |
| 1639586076 | Baptist Heart | Internal Medicine | 501 Marshall St, Suite 104, Jackson, MS 39202-1651 | 2014-07-17 |
| 1568709574 | Medical Foundation of Central Ms | Surgery | 501 Marshall St, Suite 500, Jackson, MS 39202-1651 | 2013-01-10 |
| 1417291451 | Urogyn Diagnostics LLC | Obstetrics & Gynecology | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2012-11-15 |
| 1548513617 | Southeast Urogyn LLC | Obstetrics & Gynecology | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2012-10-26 |
| 1477825800 | The Medical Foundation of Central Mississippi | Clinic/Center | 501 Marshall St, Suite 100, Jackson, MS 39202-1651 | 2012-02-01 |
| 1265712145 | Laurie Selman Nimon | Nurse Practitioner | 501 Marshall St, Suite 600, Jackson, MS 39202-1651 | 2011-08-23 |
| 1992034771 | Southeast Urogynecology Pa | Urology | 501 Marshall St, Suite 607-a, Jackson, MS 39202-1651 | 2009-12-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972150084 | Wound Management Specialists, LLC | Clinic/Center | 1190 N State St Ste 2a, Jackson, MS 39202-2413 | 2019-08-22 |
| 1700449329 | Cycle 8 Health Care, LLC | Clinic/Center | 2310 Highway 80 W Ste 2260, Jackson, MS 39204-2383 | 2019-04-18 |
| 1093286544 | East Endocrine and Metabolism Pllc | Clinic/Center | 3829 Greentree Pl, Jackson, MS 39211-6737 | 2018-12-10 |
| 1760965206 | Hunter Assets Holding LLC | Clinic/Center | 1035 W Mayes St, Jackson, MS 39213-6100 | 2018-09-11 |
| 1235634759 | W A Foote Memorial Hospital Inc | Clinic/Center | 2200 Springport Rd Ste 230, Jackson, MI 49202-1432 | 2018-03-27 |
| 1336644897 | W A Foote Memorial Hospital Inc | Clinic/Center | 3305 Spring Arbor Rd Ste 500, Jackson, MI 49203-3795 | 2018-03-27 |
| 1730684580 | W. A. Foote Memorial Hospital, Inc. | Clinic/Center | 2200 Springport Rd Ste 210, Jackson, MI 49202-1432 | 2018-03-26 |
| 1164927844 | W. A. Foote Memorial Hospital, Inc. | Clinic/Center | 2200 Springport Rd Ste 800, Jackson, MI 49202-1432 | 2018-03-26 |
| 1225532120 | Robert Greer Do, LLC | Clinic/Center | 5345 Farnsworth Dr, Jackson, MS 39211-4604 | 2018-03-23 |
| 1447761713 | Celestial Health Creations | Clinic/Center | 7 Lakeland Cir Ste 300, Jackson, MS 39216-5022 | 2017-10-13 |
| 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.