| Jackson Neuroscience Center | |
|
6514 Highway 90a Ste 101 Sugar Land TX 77498-2120 | |
| (281) 915-2370 | |
| (281) 915-2374 |
| Full Name | Jackson Neuroscience Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6514 Highway 90a Ste 101, Sugar Land, Texas |
| Authorized Official Name and Position | Danny Vining (CLINIC MANAGER) |
| Authorized Official Contact | 6012149385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Neuroscience Center Po Box 2936 Sugar Land TX 77487-2936 Ph: () - | Jackson Neuroscience Center 6514 Highway 90a Ste 101 Sugar Land TX 77498-2120 Ph: (281) 915-2370 |
| NPI Number | 1043961170 |
|---|---|
| Provider Enumeration Date | 01/11/2022 |
| Last Update Date | 08/25/2022 |
| Certification Date | 07/22/2022 |
| Medicare PECOS PAC ID | 7214321215 |
|---|---|
| Medicare Enrollment ID | O20220802000183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043961170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Danny Vining |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306175138 PECOS PAC ID: 9032233747 Enrollment ID: I20210810000927 |
| Provider Name | Daniel Gerard Jemison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699296509 PECOS PAC ID: 4486911617 Enrollment ID: I20210816002625 |
| Provider Name | Sayed Aamir Raza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699785188 PECOS PAC ID: 2264439447 Enrollment ID: I20220316000027 |
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