| Jackson Family Clinic, Inc | |
|
545 Broadridge Jackson MO 63755 | |
| (573) 243-8408 | |
| (573) 243-0445 |
| Full Name | Jackson Family Clinic, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 545 Broadridge, Jackson, Missouri |
| Authorized Official Name and Position | Kennett D Asher (OWNER) |
| Authorized Official Contact | 5732438408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Family Clinic, Inc 545 Broadridge Jackson MO 63755 Ph: (573) 243-8408 | Jackson Family Clinic, Inc 545 Broadridge Jackson MO 63755 Ph: (573) 243-8408 |
| NPI Number | 1205950961 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 04/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205950961 | NPI | - | NPPES |
| CO9028 | Other | MO | RR MEDICARE |
| 505190207 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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