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JACKSON CLINIC PA NPI 1285629386


NPI Information

NPI: 1285629386
Provider Name: JACKSON CLINIC PA
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 44D0921688

Address:
2863 HIGHWAY 45 BYP
JACKSON, TN
ZIP 38305
Phone: (731) 664-1375
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JACKSON CLINIC PA is an internal medicine in Jackson, TN. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. JACKSON CLINIC PA NPI is 1285629386. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2863 HIGHWAY 45 BYP
JACKSON, TN
ZIP 38305-618
Phone: (731) 664-1375
Fax: (731) 664-1378

The provider's authorized official is Mark Allen .
The authorized official title is C.e.o. and has the following contact phone number (731) 422-0330.

The CLIA number assigned to this NPI record is 44D0921688 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 9/14/2005 and was last updated on 10/24/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Y00000XOtolaryngologyNo
2208000000XPediatricsNo
3208200000XPlastic SurgeryNo
42085R0202XRadiologyDiagnostic RadiologyNo
5225100000XPhysical TherapistNo
6207Q00000XFamily MedicineNo
7207RC0000XInternal MedicineCardiovascular DiseaseNo
8207RG0100XInternal MedicineGastroenterologyNo
9207RN0300XInternal MedicineNephrologyNo
10207V00000XObstetrics & GynecologyNo
11207L00000XAnesthesiologyNo
12207N00000XDermatologyNo
13207W00000XOphthalmologyNo
14207X00000XOrthopaedic SurgeryNo
15207R00000XInternal MedicineYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13370007MEDICAIDTENNESSEE

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.