| Jackson Health Services | |
|
3800 Woodward Ave Ste. 418 Detroit MI 48201-2061 | |
| (313) 831-8805 | |
| (313) 832-8206 |
| Full Name | Jackson Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 3800 Woodward Ave, Detroit, Michigan |
| Authorized Official Name and Position | Mary L. Jackson-hammond (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3138318805 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Health Services 3800 Woodward Ave Ste. 418 Detroit MI 48201-2061 Ph: (313) 831-8805 | Jackson Health Services 3800 Woodward Ave Ste. 418 Detroit MI 48201-2061 Ph: (313) 831-8805 |
| NPI Number | 1205090354 |
|---|---|
| Provider Enumeration Date | 07/17/2008 |
| Last Update Date | 07/17/2008 |
| Medicare PECOS PAC ID | 6305987546 |
|---|---|
| Medicare Enrollment ID | O20100109000148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205090354 | NPI | - | NPPES |
| 4180604 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4301046737 (Michigan) | Primary |
| Provider Name | Mary L Jackson Hammond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215015680 PECOS PAC ID: 3870634017 Enrollment ID: I20100109000122 |
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