1508994211 NPI number — JACKSON & BIGELOW MD PC

Table of content: (NPI 1508994211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508994211 NPI number — JACKSON & BIGELOW MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON & BIGELOW MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508994211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 JOSEPH DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-8636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-631-2020
Provider Business Mailing Address Fax Number:
989-835-6686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 JOSEPH DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-8636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-631-2020
Provider Business Practice Location Address Fax Number:
989-835-6686
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-631-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104430921 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0256160001 . This is a "DMERC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103085182 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180E645300 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103103914 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN3193 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104430959 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180E645300 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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