| Michael R. Jackson, M.d. P.s. | |
|
5350 Orchard St W Suite 202 University Place WA 98467-4817 | |
| (253) 472-4444 | |
| Not Available |
| Full Name | Michael R. Jackson, M.d. P.s. |
|---|---|
| Speciality | Family Medicine |
| Location | 5350 Orchard St W, University Place, Washington |
| Authorized Official Name and Position | Michael R Jackson (PRESIDENT) |
| Authorized Official Contact | 2534724444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael R. Jackson, M.d. P.s. 5350 Orchard St W Suite 202 University Place WA 98467-4817 Ph: (253) 472-4444 | Michael R. Jackson, M.d. P.s. 5350 Orchard St W Suite 202 University Place WA 98467-4817 Ph: (253) 472-4444 |
| NPI Number | 1366701849 |
|---|---|
| Provider Enumeration Date | 05/03/2012 |
| Last Update Date | 05/03/2012 |
| Medicare PECOS PAC ID | 1254594435 |
|---|---|
| Medicare Enrollment ID | O20120525000529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366701849 | NPI | - | NPPES |
| 1077510 | Medicaid | WA | |
| 1043239429 | Other | NPI INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0019523 (Washington) | Primary |
| Provider Name | Michael R Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043239429 PECOS PAC ID: 5496647711 Enrollment ID: I20040330001065 |
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