JACKSON PODIATRY INC NPI 1306041744

NPI Information

NPI: 1306041744
Provider Name: JACKSON PODIATRY, INC
Classification: Podiatrist - 213ES0131X
Entity Type: Organization

Specialization: Foot Surgery

Address:
1201 BELMONT AVE
YOUNGSTOWN, OH
ZIP 44504
Phone: (330) 333-3365
Get Directions

JACKSON PODIATRY, INC is a foot surgery podiatrist in Youngstown, OH. JACKSON PODIATRY, INC NPI is 1306041744. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1201 BELMONT AVE
YOUNGSTOWN, OH
ZIP 44504
Phone: (330) 333-3365

The provider's authorized official is Derrick O Jackson .
The authorized official title is Podiatrist and has the following contact phone number (330) 398-3777.

The enumeration date for this NPI number is 6/16/2007 and was last updated on 12/28/2018.

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	213ES0131X	Podiatrist	Foot Surgery	36003456	OHIO	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	2736098	MEDICAID	OHIO

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

NPI Synchronization or Removal

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