NPIMap

Organization Active NPI

Jackson Clinic PA

Doing business as Jackson Clinc PA DME

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
National Provider Identifier
1689443038
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
JACKSON CLINIC PA
Doing business as
Jackson Clinc PA DME
Practice address
145 Innovation Dr
Jackson, TN 38305-3019
Phone
(731) 422-0213
NPI assigned
Dec 27, 2023
Last updated
Dec 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON CLINIC PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

Name
Mark Allen
Title
C.E.O.
Phone
(731) 422-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

145 Innovation Dr
Jackson, TN 38305-3019

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 423-8697

Other names 1

  • JACKSON CLINC PA DME Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241219003541 TN DME Supplier - Physician - General PracticeDME Supplier - Independently-Practicing Physical TherapistDME Supplier - Optician 2668376872 Practice locations: Jackson, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
The Jackson CL Inic PA

Locations

145 Hospital Dr
Camden, TN 38320
Phone (731) 584-3141

1700 Woodlawn Ave
Dyersburg, TN 38024
Phone (731) 286-1115

208 North Ave
Henderson, TN 38340
Phone (731) 983-3175

22 2nd Ave
Huntingdon, TN 38344

1893 S Highland Ave
Jackson, TN 38301
Phone (731) 423-5585

2863 Highway 45 Byp
Jackson, TN 38305
Phone (731) 664-1375

648 W Forest Ave
Jackson, TN 38301
Phone (731) 422-0276

68 Exeter Rd
Jackson, TN 38305
Phone (731) 201-1486

87 Murray Guard Dr
Ste B
Jackson, TN 38305
Phone (731) 664-1375

149 Commons Dr
Martin, TN 38237

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Christian Care Center of MedinaMedina, TN, CCN 445539 Skilled nursing facility Adp of the SNF Mar 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 293

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 293

NPI Registry JSON

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

{
    "created_epoch": "1703635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1689443038",
    "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": "731-425-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 INNOVATION DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053019",
            "telephone_number": "731-422-0213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CLINIC PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON CLINIC PA",
        "enumeration_date": "2023-12-27",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "731-422-0330"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON CLINC PA DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.