| Mr Samuel Robert Jackson, PA | |
|
1906 Belleview Ave Se, Roanoke, VA 24014-1838 | |
| (540) 981-7000 | |
| Not Available |
| Full Name | Mr Samuel Robert Jackson |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 1906 Belleview Ave Se, Roanoke, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699274993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 0110006058 (Virginia) | Primary |
| Entity Name | Emergency Coverage LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427005008 PECOS PAC ID: 3072412592 Enrollment ID: O20050418000414 |
| Entity Name | Emergency Coverage Services PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053351593 PECOS PAC ID: 8820983430 Enrollment ID: O20061003000679 |
| Entity Name | Lake Spring Emergency Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1215429600 PECOS PAC ID: 6406103498 Enrollment ID: O20180723001173 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Samuel Robert Jackson, PA 719 Arbutus Ave Se, Roanoke, VA 24014-2503 Ph: (404) 983-5673 | Mr Samuel Robert Jackson, PA 1906 Belleview Ave Se, Roanoke, VA 24014-1838 Ph: (540) 981-7000 |
Sarah Alyse Guzinski-homcha, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2001 Crystal Spring Ave Sw Ste 201, Roanoke, VA 24014 Phone: 540-853-0100 |
Ms. Kathryn Conrad Hoyt, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2331 Franklin Rd Sw, Roanoke, VA 24014 Phone: 540-725-1226 Fax: 540-857-5306 |
Allison Elisabeth Basiley, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 101 Elm Ave Se, Roanoke, VA 24013 Phone: 540-831-1684 |
Mr. Jason Andrew Peery, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2331 Franklin Rd Sw, Roanoke, VA 24014 Phone: 540-510-6200 Fax: 540-857-5306 |
Nicole Maalouf Shively, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1622 Westover Ave Sw, Roanoke, VA 24015 Phone: 339-368-1887 |
Jared Waters, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5673 Airport Rd, Roanoke, VA 24012 Phone: 540-523-8080 |
Mrs. Melissa L Swihart, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4035 Electric Rd Ste A, Roanoke, VA 24018 Phone: 540-772-8670 Fax: 540-772-7901 |