NPIMap

Organization Active NPI

Jackson Physician Corp

Doing business as Jackson Foot and Ankle Clinic

  • Durable Medical Equipment & Medical Supplies
  • Jackson, KY
National Provider Identifier
1164722807
Registry record updated May 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
JACKSON PHYSICIAN CORP
Doing business as
Jackson Foot and Ankle Clinic
Practice address
424 Jett Dr
Jackson, KY 41339-9621
Phone
(606) 666-5354
Fax
(606) 666-4857
NPI assigned
Oct 28, 2010
Last updated
May 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2012

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

Authorized official

Name
Debbie Brewer
Title
Director
Phone
(877) 892-9813

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X TN Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X KY

Addresses

Primary practice location

424 Jett Dr
Jackson, KY 41339-9621

Mailing address

424 Jett Dr
Jackson, KY 41339-9621
Phone (606) 666-5354

Other names 1

  • Jackson Foot and Ankle Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Booneville Medical Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1164722807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 JETT DR",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399621",
            "telephone_number": "606-666-5354",
            "fax_number": "606-666-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 JETT DR",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399621",
            "telephone_number": "606-666-5354",
            "fax_number": "606-666-4857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PHYSICIAN CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Foot and Ankle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; 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.