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NPI Code Detail

MEDICARE: FAMILY HEALTHCARE OF JACKSON

MEDICARE: FAMILY HEALTHCARE OF JACKSON
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
1207Q00000XFamily Medicine Physician30977TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407948961
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY HEALTHCARE OF JACKSON
Provider Business Mailing Address
First Line : 2815 N HIGHLAND AVE
Second Line : SUITE C
City : JACKSON
State : TN
Zip : 38305-1729
Country : US
Telephone Number : 731-660-6055
Fax Number : 731-660-6039
Provider Business Practice Location Address
First Line : 2815 N HIGHLAND AVE
Second Line : SUITE C
City : JACKSON
State : TN
Zip : 38305-1729
Country : US
Telephone Number : 731-660-6055
Fax Number : 731-660-6039
Authorized Official
Title or Position : OWNER
Name : EARL L STEWART
Credential : MD
Telephone Number : 731-660-6055
Provider Enumeration Date : 09/29/2006
Last Update Date : 08/22/2020

Similar Medicare Providers

1396837852 — EARL L STEWART MD
Practice Location Address:
2815 N HIGHLAND AVE , SUITE C
JACKSON, TN
38305-1729
Practice Phone: 731-660-6055
Practice Fax: 731-660-6039
1164820460 — LUTHERAN CHILD AND FAMILY SERVICE OF ILLINOIS
Practice Location Address:
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Practice Phone: 815-409-4440
Practice Fax:
1871039701 — AN&U INC
Practice Location Address:
1729 S JACKSON ST
JACKSONVILLE, TX
75766-5832
Practice Phone: 903-284-6256
Practice Fax: 903-284-6243
1346802394 — ANUP CHABRA
Practice Location Address:
1729 S JACKSON ST
JACKSONVILLE, TX
75766-5832
Practice Phone: 903-284-6256
Practice Fax:
1801458872 — DR. RAVISH NITINKUMAR SHAH PHARMD
Practice Location Address:
1729 S JACKSON ST
JACKSONVILLE, TX
75766-5832
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Practice Fax: 903-284-6243
1093462004 — AN&U INC
Practice Location Address:
1729 S JACKSON ST
JACKSONVILLE, TX
75766-5832
Practice Phone: 903-284-6256
Practice Fax: 903-284-6243

Directions to “FAMILY HEALTHCARE OF JACKSON ” Practice Location

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