Jackson, Calvin

Jackson, Calvin is an individual health care provider with primary practice located at 1311 N Dixie Hwy , Elizabethtown KY 42701-2621. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Jackson, Calvin can be contacted via phone (270) 769-1304.

Contact Information

Primary practice address
1311 N Dixie Hwy Elizabethtown KY 42701-2621
Phone: (270) 769-1304
Fax: (270) 234-8028
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 0274 Kentucky

Profile Details

NPI number 1649226549
LBN Legal business name Jackson, Calvin
Credentials LPA
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Mar 29th, 2008 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649226549 NPPES
Kentucky Other 000000338946 ANTHEM
Kentucky MEDICAID 30605018 ANTHEM

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