NPIMap

Organization Active NPI

Jackson Primary Care LLC

  • Primary Care Clinic/Center
  • Jackson, MO
National Provider Identifier
1790213676
Registry record updated May 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JACKSON PRIMARY CARE LLC
Practice address
2685 E Main St Ste a
Jackson, MO 63755-2474
Phone
(573) 204-1400
Fax
(573) 204-1480
NPI assigned
May 23, 2017
Last updated
May 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2017

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

Authorized official

Name
Joan L Mayberry
Title
Office Manager
Phone
(573) 204-1400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Rural Health Clinic/Center 261QR1300X 106442 MO

Addresses

Primary practice location

2685 E Main St Ste a
Jackson, MO 63755-2474

Mailing address

2685 E Main St Ste a
Jackson, MO 63755-2474
Phone (573) 204-1400

National Provider Directory

National Provider Directory
Tax ID family
Jackson Primary Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495670400000",
    "number": "1790213676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2685 E MAIN ST STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552474",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 E MAIN ST STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552474",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-23",
        "last_updated": "2017-05-25",
        "status": "A",
        "authorized_official_last_name": "MAYBERRY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-204-1400"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "106442",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2017; 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.