SOUTH JACKSON WIC DISTRIBUTION
NPI 1366853004
Public Health or Welfare in Jackson, MS
NPI Status: Active since May 15, 2014
Contact Information
3276 LYNCH ST
JACKSON, MS
ZIP 39209
Phone: (601) 969-5730
Fax: (601) 969-5729
- Organization
- Public Health or Welfare
- CLIA Number: 25D0931907
- CLIA Cert. Type: Community Clinic
- CLIA Exp. Date: 08-06-2027
About SOUTH JACKSON WIC DISTRIBUTION
This page provides the complete NPI Profile along with additional information for South Jackson Wic Distribution, a provider established in Jackson, Mississippi operating as a Public Health Or Welfare. The healthcare provider is registered in the NPI registry with number 1366853004 assigned on May 2014. The practitioner's primary taxonomy code is 251K00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's other name is South Jackson Wic Distribution. The authorized official of this NPI record is Mr. Mitchell Adcock Cao (Chief Administrative Officer)
- NPI
- 1366853004
- Provider Legal Name
- MISSISSIPPI STATE DEPARTMENT OF HEALTH
- Other Organization Name
- SOUTH JACKSON WIC DISTRIBUTION
- Other Name Type
- Other Name (5)
- Entity Type
- Organization
- Location Address
- 3276 LYNCH ST JACKSON, MS 39209
- Location Phone
- (601) 969-5730
- Location Fax
- (601) 969-5729
- Mailing Address
- 570 E WOODROW WILSON AVE JACKSON, MS 39216
- Mailing Phone
- (601) 576-7635
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-15-2014
- Last Update Date
- 05-15-2014
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Public Health or Welfare
- Taxonomy Code
- 251K00000X
- Type
- Agencies
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D0931907
- Facility Type
- Community Clinic
- Certificate Effective Date
- August 07, 2025
- Certificate Expiration Date
- August 06, 2027
- Laboratory Director
- LYNDA ASSAD
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to South Jackson Wic Distribution in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1366853004, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1366853004, enumerated as an "organization" on May 15, 2014.
The provider is located at 3276 LYNCH ST JACKSON, MS 39209 and the phone number is (601) 969-5730.
Public Health or Welfare with taxonomy code 251K00000X.
