MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC (NPI# 1548720527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548720527 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC |
| Other Organization Name | LOUISIANA CENTER FOR ADVANCED MEDICINE |
| Practice Address |
2053 Gause Blvd E Ste 200 Slidell LA 70461-5451 |
| Mailing Address |
7731 Old Canton Rd Ste B Madison MS 39110-6115 |
| Practice Telephone | 9852598045 |
| Practice Fax Number | 6014990311 |
| Mailing Telephone | 6014990935 |
| Mailing Fax Number | 6014990311 |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2019-09-25 |
| Authorized Official Name | SPENCER K SULLIVAN (CEO/OWNER) |
| Authorized Official Telephone | 6014990935 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Louisiana Center for Advanced Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790227627 | Mississippi Center for Advanced Medicine, PC | Specialist | 7731 Old Canton Rd, Suite B, Madison, MS 39110-6114 | 2016-11-09 |
| 1508426917 | Mississippi Center for Advanced Medicine, PC | Specialist | 2053 Gause Blvd E Ste 200, Slidell, LA 70461-5451 | 2019-06-18 |
| Street Address |
2053 GAUSE BLVD E STE 200 |
| City | SLIDELL |
| State | LA |
| Zip Code | 70461-5451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710900758 | Tammuella Evelyn Chrisentery-singleton | Pediatrics | 2053 Gause Blvd E Ste 200, Slidell, LA 70461-5451 | 2006-07-25 |
| 1508426917 | Mississippi Center for Advanced Medicine, PC | Specialist | 2053 Gause Blvd E Ste 200, Slidell, LA 70461-5451 | 2019-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013553577 | Kira Gilmore Smith | Nurse Practitioner | Pelican Urgent Care, 2375 Gause Blvd. East, Slidell, LA 70461 | 2019-11-20 |
| 1104477256 | Peter Khong | Pharmacy | 2915 Us-190, Mandeville, LA 70461 | 2019-09-20 |
| 1457844706 | April Hughes Whitfield | Counselor | 1313 Brownswitch Rd, Ste D, Slidell, LA 70461 | 2018-06-12 |
| 1154824761 | Lisa Michele Mcclinton | Counselor | 1212 Montgomery Blvd, Slidell, LA 70461 | 2018-03-10 |
| 1952816902 | Keiona Monae Thompson | Counselor | 1121 Clairise Ct, Slidell, LA 70461 | 2017-12-12 |
| 1275048688 | Aisha Cade | Counselor | 250 Cross Gates Blvd, Slidell, LA 70461 | 2017-12-07 |
| 1598285405 | Sureway Transits | Non-emergency Medical Transport (VAN) | 135 Rue De La Paix, Slidell, LA 70461 | 2017-06-21 |
| 1043743198 | Natasha Hunter | Counselor | 1650 Barrymore St, Slidell, LA 70461 | 2017-04-05 |
| 1154873891 | Chaise A Bennett | Physical Therapist | 2040 Gause Blvd, Suite 6, Slidell, LA 70461 | 2016-10-28 |
| 1104373539 | Kaonta Simmons | Counselor | 2185 Wellington Ln, Slidell, LA 70461 | 2016-09-01 |
| Find all providers in zip 70461 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366083164 | Genoa Healthcare, LLC | Pharmacy | 2331 Carey St Ste 101, Slidell, LA 70458-3627 | 2019-10-02 |
| 1124433784 | Walgreen Co | Pharmacy | 1051 Gause Blvd Ste 101, Slidell, LA 70458-2951 | 2014-06-23 |
| 1629497904 | Healthscripts of America-north Shore, LLC | Pharmacy | 101 Production Dr, Suite D, Slidell, LA 70460-4674 | 2014-04-15 |
| 1912028937 | Pharmacy City LLC | Pharmacy | 1201 Robert Blvd, Slidell, LA 70458-2015 | 2007-04-03 |
| 1013016070 | F and M Specialty Pharmacy Inc | Pharmacy | 118 Village St, Suite D, Slidell, LA 70458-5302 | 2006-09-22 |
| 1124122056 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 1305 Gause Blvd, Slidell, LA 70458-3015 | 2006-09-12 |
| 1871514158 | Winn Dixie Stores Inc | Pharmacy | 2985 Gause Blvd E, Slidell, LA 70461-4154 | 2006-07-21 |
| 1780605063 | Winn Dixie Stores Inc | Pharmacy | 3030 Pontchartrain Dr, Slidell, LA 70458-4352 | 2006-07-21 |
| 1528670924 | Thanh Johnny Le | Pharmacy | 1305 Gause Blvd, Slidell, LA 70458-3015 | 2020-08-18 |
| 1013568047 | Ochsner Pharmacy and Wellness LLC | Pharmacy | 1051 Gause Blvd Ste 101, Slidell, LA 70458-2951 | 2019-09-20 |
| Find all providers in SLIDELL | ||||
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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.