| Patricia Jackson Md, Llc | |
|
1111 Medical Center Blvd Suite N408 Marrero LA 70072 | |
| (504) 349-2908 | |
| (504) 378-0019 |
| Full Name | Patricia Jackson Md, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1111 Medical Center Blvd, Marrero, Louisiana |
| Authorized Official Name and Position | James O Theis (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 5043492908 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patricia Jackson Md, Llc 6019 Constance St New Orleans LA 70118-5806 Ph: (504) 349-2908 | Patricia Jackson Md, Llc 1111 Medical Center Blvd Suite N408 Marrero LA 70072 Ph: (504) 349-2908 |
| NPI Number | 1952409567 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/21/2018 |
| Medicare PECOS PAC ID | 7911072335 |
|---|---|
| Medicare Enrollment ID | O20080820000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952409567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Patricia Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326146036 PECOS PAC ID: 4385603729 Enrollment ID: I20041011000042 |
| Provider Name | James O Theis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780773440 PECOS PAC ID: 2668542978 Enrollment ID: I20080529000372 |
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