MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC (NPI# 1629510540) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629510540 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC |
| Other Organization Name | JACKSON COMPREHENSIVE TREATMENT CENTER |
| Practice Address |
1935 Lakeland Dr Ste 900 Jackson MS 39216-5028 |
| Practice Telephone | 8772917451 |
| Mailing Telephone | 8772917451 |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2017-03-03 |
| Authorized Official Name | JOHN PELOQUIN (PRESIDENT, CTC DIVISION) |
| Authorized Official Telephone | 8552592288 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Jackson Comprehensive Treatment Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467998344 | Mississippi Comprehensive Treatment Centers, LLC | Clinic/Center | 14070 Dedeaux Rd, Gulfport, MS 39503-4502 | 2017-01-16 |
| Street Address |
1935 LAKELAND DR STE 900 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-5028 |
| 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 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 261QM2800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Methadone Clinic |
| An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871752105 | Raleigh Professional Associates | Clinic/Center | 1869 Highway 45 Byp, Suite 5, Jackson, TN 38305-2464 | 2008-06-02 |
| 1164878419 | Ann Marshall | Clinic/Center | 2964 Terry Rd, Jackson, MS 39212-3055 | 2016-05-05 |
| 1093963944 | South Georgia Treatment, Inc | Clinic/Center | 794 Mcdonough Rd, Jackson, GA 30233-1572 | 2008-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861928541 | Metro Treatment of Mississippi Lp | Clinic/Center | 8900 Delta Bluffs Cove, Walls, MS 38680 | 2017-05-02 |
| 1124559976 | Metro Treatment of Mississippi, Lp | Clinic/Center | 1989 Pass Rd, Biloxi, MS 39531-4103 | 2017-03-23 |
| 1336688845 | Metro Treatment of Mississippi, Lp | Clinic/Center | 2419 10th St, Meridian, MS 39301-5040 | 2017-02-16 |
| 1467998344 | Mississippi Comprehensive Treatment Centers, LLC | Clinic/Center | 14070 Dedeaux Rd, Gulfport, MS 39503-4502 | 2017-01-16 |
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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.