Toddy Jack, CEO

Primary specialty

ContractorTaxonomy code 171W00000X

License

345782195 Issued in TX

Practice address

801 Road to Sixflags Street
144
Arlington, TX 76012

Phone

(817) 461-0034

Fax

(817) 461-0035

NPI assigned

Jan 3, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294012800000",
    "number": "1831493063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ROAD TO SIXFLAGS STREET",
            "address_2": "144",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76012",
            "telephone_number": "817-461-0034",
            "fax_number": "817-461-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 ROAD TO SIXFLAGS STREET",
            "address_2": "144",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "76012",
            "telephone_number": "817-461-0034",
            "fax_number": "817-461-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "TODDY",
        "credential": "CEO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-03",
        "last_updated": "2011-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Oncology",
            "state": "TX",
            "license": "4765290876",
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "TX",
            "license": "345782195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLE LICENCE",
            "identifier": "6787445908",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack G Brooks MD PA
• Jack Henry Arlington, LLC
• Jack Jones Hearing Centers, Inc.
• Jack Jordan Jones Enterprises
• Roselyn Addy Jack, BSC,CFTS
• Tonsel Jack
• Elin Jacks, LCSW
• Jackson Care LLC
• Jackson Elite Professionals, LLC
• Arletra Jackson

• Contractor in Arlington, TX
• Providers in Arlington, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.