MEDICARE: DR. JAMES LEE JACKSON MD

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	207RP1001X	Pulmonary Disease Physician	23520	KY
2	207R00000X	Internal Medicine Physician	23520	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1376542951	OTHER	KY	RAILROAD MEDICARE
2	C30629	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000048738	OTHER	KY	ANTHEM BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LEE JACKSON MD

Provider Business Mailing Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	SUITE M
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-227-7538
Fax Number	:	502-227-9248

Provider Business Practice Location Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	SUITE M
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-227-7538
Fax Number	:	502-227-9248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/20/2022

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Directions to “ DR. JAMES LEE JACKSON MD” Practice Location

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