JACKSON VAMC (NPI# 1841232097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841232097 |
| Entity Type | Organization |
| Organization Name | JACKSON VAMC |
| Other Organization Name | KOSCIUSKO VA CLINIC |
| Practice Address |
405 W Adams St Kosciusko MS 39090-3617 |
| Mailing Address |
Po Box 94497 Cleveland OH 44101-4497 |
| Practice Telephone | 6153553451 |
| Mailing Telephone | 6153553451 |
| Enumeration Date | 2006-06-12 |
| 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 |
|---|---|
| KOSCIUSKO VA CLINIC | 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 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
| 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 |
405 W ADAMS ST |
| City | KOSCIUSKO |
| State | MS |
| Zip Code | 39090-3617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508371675 | Caroline Boydstun Fair | Pharmacist | 109 Northside Center, Kosciusko, MS 39090 | 2017-12-11 |
| 1275069643 | Sharhonda Wingo | Speech-Language Pathologist | 2447 Attala Road 2203, Kosciusko, MS 39090 | 2017-05-04 |
| 1013392034 | Leap of Faith LLC | Respite Care | 115 North Wells Street, Suite A, Kosciusko, MS 39090 | 2015-07-21 |
| 1730566027 | Bmc - Attala, LLC | General Acute Care Hospital | 220 Hwy. 12 West, Kosciusko, MS 39090 | 2015-05-06 |
| 1528402484 | Warner Martin Myers I | Student in an Organized Health Care Education/Training Program | 912 Hwy 12 East, Kosciusko, MS 39090 | 2013-04-23 |
| 1891022547 | Medical Foundation of Central Mississippi | Internal Medicine | 329 Highway 12 West, Koscuisko, MS 39090 | 2009-11-17 |
| 1255512448 | Cheryl L Bayne | Adult Companion | 509 Hillview Dr, Kosciusko, MS 39090 | 2007-11-16 |
| 1760673982 | Gary A Cochran | Technician/Technologist | 118 West North St, Kosciusko, MS 39090 | 2007-08-05 |
| 1639396393 | Stephen C Hammack | Family Medicine | 332 Highway 12 West, Kosciusko, MS 39090 | 2007-04-20 |
| 1740329689 | Brenda Nail | Nurse Practitioner | 999 Martin Luther King Drive, Kosciusko, MS 39090 | 2007-02-06 |
| Find all providers in zip 39090 | ||||
| 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 |
| 1043250418 | Jackson Vamc | Clinic/Center | 1502 S Colorado St, Greenville, MS 38703-7219 | 2006-06-07 |
| 1669410288 | Jackson Vamc | Clinic/Center | 2103 13th St, Meridian, MS 39301-4045 | 2006-06-04 |
| 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 | ||||
Please comment or provide details below to improve the information on JACKSON VAMC.
| 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.