NPIMap

Organization Active NPI

Jackson Peg Tube Stands

  • Parenteral & Enteral Nutrition Supplies (DME)
  • Louisa, KY
National Provider Identifier
1740559988
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X
Legal business name
JACKSON PEG TUBE STANDS
Practice address
322 S Jefferson St
Louisa, KY 41230-1316
Phone
(606) 638-3234
NPI assigned
Dec 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Authorized official

Name
Mark JacksonNPI 1477860757
Title
President
Phone
(606) 638-3234

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
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X Primary

Addresses

Primary practice location

322 S Jefferson St
Louisa, KY 41230-1316

Mailing address

322 S Jefferson St
Louisa, KY 41230-1316
Phone (606) 638-3234

National Provider Directory

National Provider Directory

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": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1740559988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 S JEFFERSON ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301316",
            "telephone_number": "606-638-3234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 S JEFFERSON ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301316",
            "telephone_number": "606-638-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PEG TUBE STANDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-638-3234"
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisa, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.