MY BROTHER'S KEEPER, INC (NPI# 1609128339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609128339 |
| Entity Type | Organization |
| Organization Name | MY BROTHER'S KEEPER, INC |
| Practice Address |
805 E River Pl Jackson MS 39202-3486 |
| Practice Telephone | 6015007660 |
| Practice Fax Number | 7692437946 |
| Mailing Telephone | 6015007660 |
| Mailing Fax Number | 7692437946 |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2018-04-16 |
| Authorized Official Name | JUNE A GIPSON (PRESIDENT/CEO) |
| Authorized Official Telephone | 6019573625 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 500 E Woodrow Wilson Ave Ste M, Jackson, MS 392164538 | 6015007660 | 6019573640 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | MY BROTHER'S KEEPER, INC. | 30 Soundview Road, Guilford, CT 06437 |
| Street Address |
805 E RIVER PL |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-3486 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750641759 | Brittany Brooks | Family Medicine | 805 E River Pl, Jackson, MS 39202-3486 | 2012-05-23 |
| 1487118964 | Eugenia Boldyreva | Nurse Practitioner | 805 E River Pl, Jackson, MS 39202-3486 | 2019-01-29 |
| 1629578273 | Orlesha Carroll Bishop | Nurse Practitioner | 805 E River Pl, Jackson, MS 39202-3486 | 2018-02-20 |
| 1225556319 | Open Arms Healthcare Center | Clinic/Center | 805 E River Pl, Jackson, MS 39202-3486 | 2017-09-08 |
| 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.