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General NPI Number Information
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NPI Number | 1407100274
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Entity Type | Organization
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Legal Business Name | JACKSON MEDICAL PRODUCTS, LLC
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 77 BUSINESS PARK DR
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City | LEBANON
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State | TN
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Zip | 37090-1237
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Country | US
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Telephone | 877-453-3531
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Fax | 855-453-3541
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Provider Business Mailing Address
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Address Line | 77 BUSINESS PARK DR
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City | LEBANON
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State | TN
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Zip | 37090-1237
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Country | US
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Telephone | 877-453-3531
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Fax | 855-453-3541
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL CAMPBELL
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Credential |
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Telephone | 615-517-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0511759
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License Number State | TN
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