Jackson Pathology Group a Professional Corporation
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Jackson, TN
NPI 1679736516 · NPPES record last updated Sep 5, 2008
Key facts
- NPI
- 1679736516
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- JACKSON PATHOLOGY GROUP A PROFESSIONAL CORPORATION
- Practice address
- 708 W Forest Ave
Jackson, TN 38301-3901 - Phone
- (731) 541-6026
- Fax
- (731) 541-7958
- NPI assigned
- Jul 9, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Christopher S Giampapa, MD
- Title
- Secretary/Treasurer
- Phone
- (731) 541-6026
Practitioners 7
-
Steven K Ellsworth, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081008000663 | TN | Part B Supplier - Clinic/Group Practice | 9537237169 |
Receives reassigned benefits from 7 practitioners Practice locations: Jackson, TN |
National Provider Directory
Locations
935 Wayne Rd
Savannah, TN 38372
Phone (731) 925-4954
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Blood Banking & Transfusion Medicine Physician |
207ZB0001X | TN | ||
| Cytopathology Physician |
207ZC0500X | TN | ||
| Hematology (Pathology) Physician |
207ZH0000X | TN | ||
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | TN | Yes |
Addresses
Primary practice location
708 W Forest Ave
Jackson, TN 38301-3901
Mailing address
708 W Forest Ave
Jackson, TN 38301-3901
Phone (731) 541-6026
Other providers in Jackson, TN
- Jackson Madison General Hospital
- Jackson Madison Surgery Center LLC
- Jackson Medical Services
- Jackson OB-GYN Associates, P.C.
- Jackson Ophthalmology ASC LLC
- Jackson Pulmonary Care, PA
- Jackson Radiology Associates PA
- Jackson Regional Womens Center
- Jackson Residential, LLC
- Jackson Senior Services, LLC
All providers in Jackson, TN · Anatomic Pathology & Clinical Pathology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.