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ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
NPI 1003979386
Pharmacy - Institutional Pharmacy in Jackson, MS

Active since December 18, 2006CLIA Certified · 2 labs
969 LAKELAND DR, JACKSON, MS 39216(601) 200-6000(601) 321-5170 Get Directions Write a Review

NPPES record last updated: May 13, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 13, 2024, Aug 22, 2020 (2 updates tracked since 2020).

About St. Dominic-jackson Memorial Hospital NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. DOMINIC-JACKSON MEMORIAL HOSPITAL (NPI 1003979386) is a healthcare organization registered as an institutional pharmacy in Jackson, Mississippi and active in the NPI registry since December 2006. The organization holds 2 active CLIA laboratory certificates and lists Samuel Thaddeus Scott, Cfo, as its authorized official.

NPPES Registry Identity

NPI1003979386
Entity TypeOrganization
Primary Taxonomy3336I0012X
Legal Business NameST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Location Address969 LAKELAND DRJackson, MS 39216-4606
Mailing Address969 Lakeland DrJackson, MS 39216-4606 · (601) 200-6000 · Fax (601) 321-5170
Phone(601) 200-6000
Fax(601) 321-5170
Organization SubpartNo
Authorized OfficialSamuel Thaddeus ScottCfo · (601) 200-6570
Enumeration DateDecember 18, 2006
Last NPPES UpdateMay 13, 20242 updates tracked since enumeration
NPPES CertifiedMay 13, 2024
✔ NPI 1003979386 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Institutional PharmacySuppliers
Taxonomy Code3336I0012X
License✔ Licensed in MS · 0101003.1
Definition
A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
969 LAKELAND DR, Jackson, MS 39216
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Other Identifiers 2

Other20034MS · Blue Cross
Medicaid000020034MS

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 25D0318532

St Dominic-Jackson Memorial Hospital-Main Lab Dba Fmol Health-St Dominic · Jackson, MS
Active · expires Jan 2, 2027
CLIA Number25D0318532
Laboratory TypeHospital
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorDr. Randall S. Smith
Laboratory Phone(601) 200-4940
Laboratory LocationSt Dominic-Jackson Memorial Hospital-Main Lab Dba Fmol Health-St Dominic969 Lakeland Dr, Jackson, MS 39216
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Accreditation 25D0700595

St Dominic-Jackson Memorial Hospital - Poc Lab Dba Fmol Health-St Dominic · Jackson, MS
Active · expires Jan 2, 2027
CLIA Number25D0700595
Laboratory TypeHospital
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorDr. Randall S. Smith
Laboratory Phone(601) 200-4940
Laboratory LocationSt Dominic-Jackson Memorial Hospital - Poc Lab Dba Fmol Health-St Dominic969 Lakeland Dr, Jackson, MS 39216
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HNI MEDICAL SERVICES OF MISSISSIPPI, LLC
Internal Medicine
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-2000
TAMECIA HERBERT NURSE PRACTITIONER
Nurse Practitioner
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 622-7749
ZACHARY HALLIWELL CRNA
Nurse Anesthetist, Certified Registered
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-2000
BRITTANY BOYKIN FNP-C
Nurse Practitioner (Family)
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-5900
LISA PARKER
Nurse Practitioner (Family)
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-2000
SARAH D BAKER
Nurse Practitioner (Family)
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-2000
MARSHALL JAMES STOUT M.D.
Emergency Medicine
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-2000
EDWARD GREEN MD
Radiology (Diagnostic Radiology)
969 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-6162

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Dominic-Jackson Memorial Hospital's NPI number?

The NPI number for St. Dominic-Jackson Memorial Hospital is 1003979386. It was assigned to this organization in the NPPES registry on December 18, 2006.

Where is St. Dominic-Jackson Memorial Hospital located?

St. Dominic-Jackson Memorial Hospital is located at 969 Lakeland Dr, Jackson, MS 39216. The listed phone number is (601) 200-6000.

What is St. Dominic-Jackson Memorial Hospital's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Institutional Pharmacy, with taxonomy code 3336I0012X.

Does St. Dominic-Jackson Memorial Hospital hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for St. Dominic-Jackson Memorial Hospital was last updated on May 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.