NPIMap

Organization Active NPI

Jackson Healthcare

  • General Practice Physician
  • Shelbyville, KY
National Provider Identifier
1639359565
Registry record updated Nov 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
18425 Issued in KY
Legal business name
JACKSON HEALTHCARE
Practice address
148 Midland Blvd
Shelbyville, KY 40065-9734
Phone
(502) 647-1958
Fax
(502) 647-1940
NPI assigned
Nov 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2007

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

Authorized official

Name
Dr. William J Jackson, MDNPI 1447288709
Title
Owner/Doctor
Phone
(502) 647-1958

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 18425 KY Primary

Addresses

Primary practice location

148 Midland Blvd
Shelbyville, KY 40065-9734

Mailing address

148 Midland Blvd
Shelbyville, KY 40065-9734
Phone (502) 647-1958

National Provider Directory

National Provider Directory

Locations

148 Midland Blvd
Shelbyville, KY 40065
Phone (502) 647-1958

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1639359565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 MIDLAND BLVD",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400659734",
            "telephone_number": "502-647-1958",
            "fax_number": "502-647-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 MIDLAND BLVD",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400659734",
            "telephone_number": "502-647-1958",
            "fax_number": "502-647-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "502-647-1958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "KY",
            "license": "18425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.