Jackson Rural Health Clinic P a

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

253949 Issued in MS

Legal business name

JACKSON RURAL HEALTH CLINIC P A

Practice address

29 S Fourth St
Rolling Fork, MS 39159-5146

Phone

(662) 873-4361

Fax

(662) 873-2921

NPI assigned

Jun 29, 2006

Last updated

Dec 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Danny Jackson, D.O.NPI 1821013095

Title

Owner

Phone

(662) 873-4361

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

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.

• Danny Wade Jackson, D.O.

  • Family Medicine Physician
  • Rolling Fork, MS
  • NPI 1821013095
  Authorized official Same address or phone
• Luther Brandon Oakes, M.D.

  • Interventional Pain Medicine Physician
  • Greenville, MS
  • NPI 1215167150

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1316975287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "ROLLING FORK",
            "state": "MS",
            "postal_code": "391590520",
            "telephone_number": "662-873-4361",
            "fax_number": "662-873-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 S FOURTH ST",
            "city": "ROLLING FORK",
            "state": "MS",
            "postal_code": "391595146",
            "telephone_number": "662-873-4361",
            "fax_number": "662-873-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON RURAL HEALTH CLINIC P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-873-4361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "253949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014136",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Yolanda Edwards
• Elt Inc.
• Freds Stores of Tennessee Inc (Freds Pharmacy 2781)
• Martin Galas
• Andrew George, MD
• Miriam Denise Jackson-Hamilton, LPC
• Danny Wade Jackson, D.O.
• Patsy Johnson, CFNP
• Kinetix Medical Equipment, LLC
• Olivia Gayle King, PTA

• Family Medicine Physician in Rolling Fork, MS
• Providers in Rolling Fork, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.