Active NPI
Lavar Jackson
- Transportation Broker
- Madison, MS
National Provider Identifier
1053914754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Transportation Broker
- Practice address
- 820 Annandale Rd
Madison, MS 39110-7827 - Phone
- (504) 250-1316
- NPI assigned
- Nov 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transportation Broker | 347E00000X | Primary |
Addresses
Primary practice location
820 Annandale Rd
Madison, MS 39110-7827
Mailing address
820 Annandale Rd
Madison, MS 39110-7827
Phone (504) 250-1316
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1053914754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 ANNANDALE RD",
"city": "MADISON",
"state": "MS",
"postal_code": "391107827",
"telephone_number": "504-250-1316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 ANNANDALE RD",
"city": "MADISON",
"state": "MS",
"postal_code": "391107827",
"telephone_number": "504-250-1316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LAVAR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "347E00000X",
"taxonomy_group": "",
"desc": "Transportation Broker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.