Jackson ENT Clinic , PSC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

36227 Issued in KY

Legal business name

JACKSON ENT CLINIC , PSC

Practice address

1550 Highway 15 S Ste 29
Jackson, KY 41339-9221

Phone

(606) 666-9909

Fax

(606) 666-9982

NPI assigned

Feb 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tariq A Sartawi, M.D.

Title

Owner

Phone

(606) 666-9909

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226620800000",
    "number": "1831225465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 768",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390768",
            "telephone_number": "606-666-9909",
            "fax_number": "606-666-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 HIGHWAY 15 S STE 29",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399221",
            "telephone_number": "606-666-9909",
            "fax_number": "606-666-9982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON ENT CLINIC , PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-11-14",
        "status": "A",
        "authorized_official_last_name": "SARTAWI",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-666-9909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "36227",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "36227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SA64023724",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Mae Holbrook, APRN
• Matthew E Holloway, CRNA
• Steven Ray Howard, D.C.
• Krista Hubbard
• John F. Inserra Jr., LPCC
• Jackson Hospital Corporation
• Jackson Hospital Corporation
• Jackson Hospital Corporation
• Jackson Hospital Corporation
• Jackson Hospital Corporation

• Otolaryngology Physician in Jackson, KY
• Providers in Jackson, KY by specialty
• Otolaryngology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; 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.