| James Jackson D.o., P.c. | |
|
2416 Peck Street James Jackson D.o., P.c. Muskegon Hts. MI 49444 | |
| (231) 739-5574 | |
| (231) 739-5574 |
| Full Name | James Jackson D.o., P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 2416 Peck Street, Muskegon Hts., Michigan |
| Authorized Official Name and Position | James Jackson (OWNER) |
| Authorized Official Contact | 23173955574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James Jackson D.o., P.c. 2416 Peck Street James Jackson D.o., P.c. Muskegon Hts. MI 49444 Ph: (231) 739-5574 | James Jackson D.o., P.c. 2416 Peck Street James Jackson D.o., P.c. Muskegon Hts. MI 49444 Ph: (231) 739-5574 |
| NPI Number | 1619289642 |
|---|---|
| Provider Enumeration Date | 07/07/2010 |
| Last Update Date | 10/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619289642 | NPI | - | NPPES |
| 1006466 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 5101004758 (Michigan) | Secondary |
| 207Q00000X | Family Medicine | JJ004758 (Michigan) | Primary |