Internal Medicine Clinic of Jackson PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD011299 Issued in TN

Legal business name

INTERNAL MEDICINE CLINIC OF JACKSON PLLC

Practice address

587 Skyline Dr
Jackson, TN 38301-3938

Phone

(731) 424-8922

Fax

(731) 423-2922

NPI assigned

Sep 23, 2008

Organization subpart

No

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

Authorized official

Name

Robert Hudson Dunnebacke, M.D,

Title

PLLC Member

Phone

(731) 668-9031

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222300800000",
    "number": "1174773428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WINDWOOD DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383058835",
            "telephone_number": "731-668-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013938",
            "telephone_number": "731-424-8922",
            "fax_number": "731-423-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE CLINIC OF JACKSON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-23",
        "last_updated": "2008-09-25",
        "status": "A",
        "authorized_official_last_name": "DUNNEBACKE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "HUDSON",
        "authorized_official_title_or_position": "PLLC MEMBER",
        "authorized_official_telephone_number": "731-668-9031",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "MD011299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3182200",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin P Inman, MD
• Innovative Physical Therapy
• Institute of Sleep Wellness, LLC
• Integrated Medical Staff of Jackson PC
• Integrity Remodling LLC
• William David Irvine, MD
• Island Park Beach Holdings LLC
• Tiffani B Ivery
• Patty S. Ivie, CASE MANAGER
• Jackson Allergy & Asthma Clinic PLLC

• Primary Care Clinic/Center in Jackson, TN
• Providers in Jackson, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; 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.