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General NPI Number Information
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NPI Number | 1205950961
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Entity Type | Organization
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Legal Business Name | JACKSON FAMILY CLINIC, INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 545 BROADRIDGE
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City | JACKSON
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State | MO
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Zip | 63755
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Country | US
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Telephone | 573-243-8408
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Fax | 573-243-0445
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Provider Business Mailing Address
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Address Line | 545 BROADRIDGE
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City | JACKSON
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State | MO
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Zip | 63755
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Country | US
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Telephone | 573-243-8408
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Fax | 573-243-0445
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETT D ASHER
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Credential | DO
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Telephone | 573-243-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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