1871557520 NPI number — ALAN M JACKSON MD

Table of content: ALAN M JACKSON MD (NPI 1871557520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871557520 NPI number — ALAN M JACKSON MD

Organization/Personal Information

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

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:
1871557520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 INDUSTRIAL RD
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01757-3736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-473-1480
Provider Business Mailing Address Fax Number:
508-473-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 COMMERCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01534-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-731-2575
Provider Business Practice Location Address Fax Number:
82-660-6085
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  50900 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0400963 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA1209 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: J02952 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J02952 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043058466 . This is a "HEALTHCARE VALUE MGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110048763 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6174345 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 934961 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: J02952 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4034907 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8465722 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8758 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29186 . This is a "CHILDRENS MED SEC PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29186 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784239 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J02952 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".




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