MEDICARE: JACKSON MEDICAL SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1932092335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON MEDICAL SPECIALISTS

Provider Business Mailing Address
First Line	:	650 E PINE ST STE 102A
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2482
Country	:	US
Telephone Number	:	541-324-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E PINE ST STE 102A
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2482
Country	:	US
Telephone Number	:	541-324-0399
Fax Number	:	541-727-0219

Authorized Official
Title or Position	:	CEO/NP
Name	:	NANCY KNECHEL
Credential	:
Telephone Number	:	541-324-0399

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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Directions to “JACKSON MEDICAL SPECIALISTS ” Practice Location

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