JACKSON VAMC (NPI# 1669410288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669410288 |
| Entity Type | Organization |
| Organization Name | JACKSON VAMC |
| Other Organization Name | MERIDIAN VA CBOC |
| Practice Address |
2103 13th St Meridian MS 39301-4045 |
| Mailing Address |
Po Box 94497 Cleveland OH 44101-4497 |
| Practice Telephone | 6153553451 |
| Mailing Telephone | 6153553451 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-10-04 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Meridian VA CBOC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
| 1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
| 1376598698 | Jackson Vamc | Clinic/Center | 5003 Hardy Street, Tower B Suite 402, Hattiesburg, MS 39402-1331 | 2006-05-24 |
| 1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
| 1154784965 | Jackson Vamc | Psychiatric Residential Treatment Facility | 1500 Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2016-03-30 |
| 1922496280 | Jackson Vamc | Clinic/Center | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2015-01-08 |
| 1467762120 | Jackson Vamc | Clinic/Center | 1308 Harrison Ave, Mccomb, MS 39648-2830 | 2010-10-15 |
| 1992754543 | Jackson Vamc | General Acute Care Hospital | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2006-05-10 |
| Street Address |
2103 13TH ST |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301-4045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992238067 | Robbi Lea Broadhead | Registered Nurse | 2103 13th St, Meridian, MS 39301-4045 | 2017-04-06 |
| 1952795502 | Kathryn Lee Fleming | Nurse Practitioner | 2103 13th St, Meridian, MS 39301-4045 | 2015-03-21 |
| 1336261239 | Deritha Marbory Barber | Social Worker | 2103 13th St, Meridian, MS 39301-4045 | 2007-04-04 |
| 1578587523 | Gayle Hamilton | Nurse Practitioner | 2103 13th St, Meridian, MS 39301-4045 | 2006-07-26 |
| 1194743336 | Deborah Jean Schultz | Internal Medicine | 2103 13th St, Meridian, MS 39301-4045 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407303050 | Jackson Vamc | Clinic/Center | 6522 Dogwood View Parkway, Suite F, Jackson, MS 39213-7858 | 2016-09-01 |
| 1841232097 | Jackson Vamc | Clinic/Center | 405 W Adams St, Kosciusko, MS 39090-3617 | 2006-06-12 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1528006152 | Jackson Vamc | Clinic/Center | 105 Northgate Rd, Suite 2, Natchez, MS 39120-9162 | 2006-06-04 |
| 1073552436 | Memphis Vamc | Clinic/Center | 1114 Commonwealth Blvd., Tupelo, MS 38804-9998 | 2006-06-04 |
| 1376598698 | Jackson Vamc | Clinic/Center | 5003 Hardy Street, Tower B Suite 402, Hattiesburg, MS 39402-1331 | 2006-05-24 |
| 1194778357 | Memphis Vamc | Clinic/Center | 1700 Crescent Meadows, Holly Springs, MS 38635-7414 | 2006-05-18 |
| 1295787364 | Jackson Vamc | Clinic/Center | 824 Alabama St, Columbus, MS 39702-5436 | 2006-05-17 |
| 1972044048 | Dewona Flowers | Clinic/Center | 604 Lexington Cv, Byram, MS 39272-3004 | 2017-03-09 |
| 1245770445 | Clinton Medical Center | Clinic/Center | 604 Lexington Cv, Byram, MS 39272-3004 | 2017-03-07 |
| Find all providers with the same taxonomy | ||||
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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.