GREG L JACKSON NPI 1063580843

NPI Information

NPI: 1063580843
Provider Name: GREG L JACKSON

Doing Business As: STAR MEDICAL SPECIALTIES

Classification: Durable Medical Equipment & Medical Supplies - 332BP3500X
Entity Type: Organization

Specialization: Parenteral & Enteral Nutrition

Address:
4386 SUNBELT DR
ADDISON, TX
ZIP 75001
Phone: (972) 380-2065
Get Directions

GREG L JACKSON is a parenteral and enteral nutrition durable medical equipment medical supplies in Addison, TX. GREG L JACKSON NPI is 1063580843. The provider is registered as an organization entity type.
The provider Is Doing Business As Star Medical Specialties.

The provider's business location address is:

4386 SUNBELT DR
ADDISON, TX
ZIP 75001
Phone: (972) 380-2065
Fax: (972) 380-9488

The provider's authorized official is Greg L Jackson .
The authorized official title is Ceo and has the following contact phone number (972) 380-2065.

The enumeration date for this NPI number is 12/1/2006 and was last updated on 10/24/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	332BP3500X	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	011564401	MEDICAID	TEXAS
2	010118001	OTHER	TEXAS	MEDICAID CCP
3	0519596	OTHER	TEXAS	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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