Greg L Jackson

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

GREG L JACKSON

Doing business as

Star Medical Specialties

Practice address

4386 Sunbelt Dr
Addison, TX 75001

Phone

(972) 380-2065

Fax

(972) 380-9488

NPI assigned

Dec 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Greg L Jackson

Title

Ceo

Phone

(972) 380-2065

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Star Medical Specialties Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1063580843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4386 SUNBELT DR",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "75001",
            "telephone_number": "972-380-2065",
            "fax_number": "972-380-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4386 SUNBELT DR",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "75001",
            "telephone_number": "972-380-2065",
            "fax_number": "972-380-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREG L JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-380-2065",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID CCP",
            "identifier": "010118001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011564401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0519596",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Medical Specialties",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Star Medical Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jordan Nicole Miller Grasshoff, OTR/L
• Kate Hanna Gray, P.T., D.P.T.
• Sarah Gray, FNP
• Great Expectations Birth
• Aliah T Green, CCC-SLP
• Crista Noel Gregoire
• Jon Justin Gregor, D.C.
• Teairra Niangel Grice
• Zhawantae Griffin-Maliti, PH.D.
• Elizabeth Grigerek, SLP

• Parenteral & Enteral Nutrition Supplies (DME) in Addison, TX
• Providers in Addison, TX by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.