Basic Information
| Provider Information | |||||||||
| NPI: | 1558396424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRIN | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 NORTH STATE STREET DIVISION OF HEMATOLOGY | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845615 | ||||||||
| FaxNumber: | 6019845689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 CHADWICK DR STE 351 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392043472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013761288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 14425 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 1412074 | 05 | LA | MEDICAID | 02450824 | 05 | MS | MEDICAID | P01236760 | 01 | MS | RAILROAD MEDICARE | OTHER | 103357 | 05 | AL | MEDICAID |