Healthcare Provider Details

I. General information

NPI: 1033163092
Provider Name (Legal Business Name): JACKSON HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1000
  • Fax: 601-376-2821
Mailing address:
  • Phone: 601-376-1000
  • Fax: 601-376-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number16240
License Number StateMS

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953