| Samantha Jackson Md Pllc | |
|
415 W Forest Ln Hobart OK 73651-1645 | |
| (580) 726-2226 | |
| (580) 726-8425 |
| Full Name | Samantha Jackson Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 415 W Forest Ln, Hobart, Oklahoma |
| Authorized Official Name and Position | Samantha L Jackson (OWNER) |
| Authorized Official Contact | 5807262226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samantha Jackson Md Pllc 415 W Forest Ln Hobart OK 73651-1645 Ph: (580) 726-2226 | Samantha Jackson Md Pllc 415 W Forest Ln Hobart OK 73651-1645 Ph: (580) 726-2226 |
| NPI Number | 1275973646 |
|---|---|
| Provider Enumeration Date | 07/01/2013 |
| Last Update Date | 01/16/2017 |
| Medicare PECOS PAC ID | 9436385978 |
|---|---|
| Medicare Enrollment ID | O20131112000284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275973646 | NPI | - | NPPES |
| 200491840A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 19876 (Oklahoma) | Primary |
| Provider Name | Samantha L Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104806967 PECOS PAC ID: 7012002744 Enrollment ID: I20070926000847 |
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