| St Dominic Family Practice Associates Madison | |
|
106 Highland Way Suite 103 Madison MS 39110-6929 | |
| (601) 200-4750 | |
| (601) 200-4740 |
| Full Name | St Dominic Family Practice Associates Madison |
|---|---|
| Speciality | Family Medicine |
| Location | 106 Highland Way, Madison, Mississippi |
| Authorized Official Name and Position | Danielle Stuart (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6012004880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Dominic Family Practice Associates Madison Po Box 23666 Jackson MS 39225-3666 Ph: (601) 200-4749 | St Dominic Family Practice Associates Madison 106 Highland Way Suite 103 Madison MS 39110-6929 Ph: (601) 200-4750 |
| NPI Number | 1245393255 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 08/31/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245393255 | NPI | - | NPPES |
| 00975207 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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