Cecil Timothy Jackson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

29774 Issued in MT

Practice address

90 Highway 91 South
C/O Barrett Hospital & Healthcare
Dillon, MT 59725-3597

Phone

(406) 683-3000

Fax

(406) 683-3011

NPI assigned

Jun 6, 2006

Last updated

Oct 13, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Steele Memorial Medical Center

  • Critical Access Hospital
  • Salmon, ID
  • NPI 1851403265
  Medicare reassignment NPD
• River of No Return Anesthesia

  • Certified Registered Nurse Anesthetist
  • Salmon, ID
  • NPI 1518126119
  Authorized official Same address or phone
• Steele Memorial Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Salmon, ID
  • NPI 1992913479
  NPD
• Bohannon Creek Enterprises, Inc.

  • Certified Registered Nurse Anesthetist
  • Dillon, MT
  • NPI 1184640104

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1851330666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834674709",
            "telephone_number": "208-756-2429",
            "fax_number": "208-756-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HIGHWAY 91 SOUTH",
            "address_2": "C/O BARRETT HOSPITAL & HEALTHCARE",
            "city": "DILLON",
            "state": "MT",
            "postal_code": "597253597",
            "telephone_number": "406-683-3000",
            "fax_number": "406-683-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CECIL",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MT",
            "license": "29774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "29774",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kandis Lee Hoem, MS SLP
• Honeybee Hospice LLC
• Alison Hueth, MOT, OTR/L
• Spencer Hughes, DMD
• Tery Allen Hursh, PA-C
• Angela Jennings
• Peter Jennings, DPM
• John B McCollum DDS PC
• Skylar Johnson
• George Robert Johnston Jr., DDS

• Certified Registered Nurse Anesthetist in Dillon, MT
• Providers in Dillon, MT by specialty
• Certified Registered Nurse Anesthetist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.