JACKSON FAMILY CLINIC INC NPI 1205950961

NPI Information

  • NPI: 1205950961
  • Provider Name: JACKSON FAMILY CLINIC, INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 545 BROADRIDGE
    JACKSON, MO
    ZIP 63755
  • Phone: (573) 243-8408

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NPI Details

JACKSON FAMILY CLINIC, INC is a family medicine in Jackson, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. JACKSON FAMILY CLINIC, INC NPI is 1205950961. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

545 BROADRIDGE
JACKSON, MO
ZIP 63755
Phone: (573) 243-8408
Fax: (573) 243-0445

The provider's authorized official is Kennett D Asher .
The authorized official title is Owner and has the following contact phone number (573) 243-8408.

The enumeration date for this NPI number is 3/19/2007 and was last updated on 4/29/2008.

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
1207Q00000XFamily 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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CO9028OTHERMISSOURIRR MEDICARE
2000013269MEDICARE ID-TYPE UNSPECIFIEDMISSOURI
3505190207MEDICAIDMISSOURI

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: 11/21/2025

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