Toddy Jack, CEO is a
Contractor based in Arlington, Texas. Toddy Jack is licensed to practice in Texas (license number 345782195) and his current practice location is
801 Road To Sixflags Street, 144, Arlington, Texas. He can be reached at his office (for appointments etc.) via phone at
(817) 461-0034.
NPI number for Toddy Jack is 1831493063 and his current mailing address is 801 Road To Sixflags Street, 144, Arlington, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1831493063.
Provider's Profile
| Full Name | Toddy Jack |
|---|
| Gender | Male |
|---|
| Speciality | Contractor |
|---|
| Location | 801 Road To Sixflags Street, Arlington, Texas |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1831493063
- Provider Enumeration Date: 01/03/2011
- Last Update Date: 01/03/2011
Medical Identifiers
Medical identifiers for Toddy Jack such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1831493063 | NPI | - | NPPES |
| 6787445908 | Other | TX | MULTIPLE LICENCE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163WX0200X | Registered Nurse - Oncology | 4765290876 (Texas) | Secondary |
| 171W00000X | Contractor | 345782195 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Toddy Jack is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Toddy Jack, CEO
801 Road To Sixflags Street, 144,
Arlington, TX 76012
Ph: (817) 461-0034 | Toddy Jack, CEO
801 Road To Sixflags Street, 144,
Arlington, TX 76012
Ph: (817) 461-0034 |
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