Healthcare Provider Details

I. General information

NPI: 1558276667
Provider Name (Legal Business Name): JACKSON DEEDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 ELKTON DR
COLORADO SPRINGS CO
80907-3536
US

IV. Provider business mailing address

3902 COTTAGE DR
COLORADO SPRINGS CO
80920-7323
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-1277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number4136-1721-4626
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: