NPIMap

Organization Active NPI

Professional Health Services of Jackson

  • Clinical Social Worker
  • Jackson, TN
National Provider Identifier
1407951684
Registry record updated Feb 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PROFESSIONAL HEALTH SERVICES OF JACKSON
Practice address
233 Oil Well Rd Ste E
Jackson, TN 38305-8014
Phone
(731) 660-8467
Fax
(731) 660-8495
NPI assigned
Sep 13, 2006
Last updated
Feb 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2009

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

Authorized official

Name
Mr. H Warren Cole
Title
Ceo/Owner
Phone
(731) 660-8467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

233 Oil Well Rd Ste E
Jackson, TN 38305-8014

Mailing address

233 Oil Well Rd Ste E
Jackson, TN 38305-8014
Phone (731) 660-8467

Other identifiers 4

IdentifierTypeStateIssuer
7567489OtherTNAETNA
3926019MedicaidTN
556710000OtherTNMAGELLAN BEHAVIORAL HEALT
3382556MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080228000357 TN Part B Supplier - Clinic/Group Practice 7416929344 Receives reassigned benefits from 6 practitioners
Practice locations: Jackson, TN

National Provider Directory

National Provider Directory

Locations

233 Oil Well Rd
Ste C
Jackson, TN 38305
Phone (731) 660-8467

233 Oil Well Rd
Ste E
Jackson, TN 38305
Phone (731) 660-8467

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235088000000",
    "number": "1407951684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 OIL WELL RD STE E",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383058014",
            "telephone_number": "731-660-8467",
            "fax_number": "731-660-8495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 OIL WELL RD STE E",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383058014",
            "telephone_number": "731-660-8467",
            "fax_number": "731-660-8495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL HEALTH SERVICES OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2009-02-20",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "H",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "731-660-8467",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7567489",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3926019",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL HEALT",
            "identifier": "556710000",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382556",
            "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 Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.