NPIMap

Organization Active NPI

Pulmonary Medicine Clinic of Jackson, PC

  • Specialist
  • Jackson, TN
National Provider Identifier
1245315860
Registry record updated Jul 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PULMONARY MEDICINE CLINIC OF JACKSON, PC
Practice address
96 Physicians Dr
Jackson, TN 38305-2070
Phone
(731) 664-8771
Fax
(731) 660-7050
NPI assigned
Oct 25, 2006
Last updated
Jul 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2015

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

Authorized official

Name
Dr. Larry W Carruth, M.D.NPI 1306835483
Title
President
Phone
(731) 664-8771

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

96 Physicians Dr
Jackson, TN 38305-2070

Mailing address

96 Physicians Dr
Jackson, TN 38305-2070
Phone (731) 664-8771

Other identifiers 1

IdentifierTypeStateIssuer
3709887MedicaidTN

National Provider Directory

National Provider Directory

Locations

96 Physicians Dr
Jackson, TN 38305
Phone (731) 664-8771

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1245315860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 PHYSICIANS DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052070",
            "telephone_number": "731-664-8771",
            "fax_number": "731-660-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 PHYSICIANS DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052070",
            "telephone_number": "731-664-8771",
            "fax_number": "731-660-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULMONARY MEDICINE CLINIC OF JACKSON, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "CARRUTH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-664-8771",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3709887",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; 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.