Jackson Clinic PA

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

0000003266 Issued in TN

Legal business name

JACKSON CLINIC PA

Doing business as

Jackson Clinic PA Laboratory

Practice address

616 W Forest Ave
Jackson, TN 38301-3902

Phone

(731) 422-0330

Fax

(731) 422-0220

NPI assigned

Sep 11, 2006

Organization subpart

No

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

Authorized official

Name

Carl E Rudd

Title

Administrator

Phone

(731) 422-0330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jackson Clinic PA Laboratory Doing business as

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376647545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-423-8697",
            "fax_number": "731-422-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013902",
            "telephone_number": "731-422-0330",
            "fax_number": "731-422-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUDD",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-422-0330"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "0000003266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "44D0315448",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Clinic PA Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jackson Anesthesia and Perioperative Consultants
• Jackson Anesthesiology Group, PLLC
• Jackson Area Council on Alcoholism and Drug Dependency
• Jackson Center for Independent Living
• Jackson Clinic PA
• Jackson Clinic PA
• Jackson Clinic Pharmacy Inc
• Jackson Clinic Pharmacy Inc
• Jackson Clinic Pharmacy Inc
• Jackson Endocrine and Diabetes Center PC

• Clinical Medical Laboratory in Jackson, TN
• Providers in Jackson, TN by specialty
• Clinical Medical Laboratory in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.