Jacks, Samuel Porter
Jacks, Samuel Porter is an individual health care provider with primary practice located at 4622 Country Club Rd Suite 180, Winston Salem NC 27104-3769. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery). Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) is his primary health care specialty. Jacks, Samuel Porter can be contacted via phone (336) 768-9535.Contact Information
Primary practice address
4622 Country Club Rd Suite 180
Winston Salem NC 27104-3769
Phone: (336) 768-9535
Fax: (336) 768-4155
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 2015-01953 | North Carolina |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 2015-01953 | North Carolina |
Profile Details
| NPI number | 1184828030 |
|---|---|
| LBN Legal business name | Jacks, Samuel Porter |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 13th, 2007 |
| Last updated | Oct 25th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184828030 | NPPES |
| Florida | MEDICAID | 005979900 | |
| Florida | MEDICAID | 003125978A | |
| Florida | Other | P01084809 |
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