| Charles W Jackson Md Inc | |
|
17122 Beach Blvd Ste. 102 Huntington Beach CA 92647-5992 | |
| (714) 847-6545 | |
| (714) 847-6547 |
| Full Name | Charles W Jackson Md Inc |
|---|---|
| Speciality | General Practice |
| Location | 17122 Beach Blvd, Huntington Beach, California |
| Authorized Official Name and Position | Charles Jackson (PRESIDENT) |
| Authorized Official Contact | 7148476545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles W Jackson Md Inc Po Box 7630 Laguna Niguel CA 92607-7630 Ph: (949) 643-3345 | Charles W Jackson Md Inc 17122 Beach Blvd Ste. 102 Huntington Beach CA 92647-5992 Ph: (714) 847-6545 |
| NPI Number | 1851594006 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 07/28/2010 |
| Medicare PECOS PAC ID | 1153453121 |
|---|---|
| Medicare Enrollment ID | O20100712000081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851594006 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | G35311 (California) | Primary |
| Provider Name | Charles W Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083662845 PECOS PAC ID: 5496641789 Enrollment ID: I20040224000853 |
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