| Jacksons Health Family Health Np | |
|
1655 Elmwood Ave Ste 125 Rochester NY 14620-3428 | |
| (585) 340-6940 | |
| Not Available |
| Full Name | Jacksons Health Family Health Np |
|---|---|
| Speciality | Clinic/Center |
| Location | 1655 Elmwood Ave Ste 125, Rochester, New York |
| Authorized Official Name and Position | Carnel Jackson (OWNER) |
| Authorized Official Contact | 5853406940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksons Health Family Health Np 978 Clinton Ave S Rochester NY 14620-2040 Ph: (585) 576-1001 | Jacksons Health Family Health Np 1655 Elmwood Ave Ste 125 Rochester NY 14620-3428 Ph: (585) 340-6940 |
| NPI Number | 1194494880 |
|---|---|
| Provider Enumeration Date | 09/07/2021 |
| Last Update Date | 09/08/2024 |
| Medicare PECOS PAC ID | 7618362682 |
|---|---|
| Medicare Enrollment ID | O20220310001119 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194494880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Corey J Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427432343 PECOS PAC ID: 8224392386 Enrollment ID: I20180426001095 |
| Provider Name | Carnel Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336523257 PECOS PAC ID: 0345504734 Enrollment ID: I20190116000516 |
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