Jackson Ent Clinic , Psc

LBN: Jackson Ent Clinic , Psc
Jackson Ent Clinic , Psc is an health care organization with primary practice located at 1550 Highway 15 S Ste 29 , Jackson KY 41339-9221. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Otolaryngology. Allopathic & Osteopathic Physicians / Otolaryngology is the primary health care specialty. Jackson Ent Clinic , Psc can be contacted via phone (606) 666-9909, or through Sartawi, Tariq A via phone (606) 666-9909.

Contact Information

Primary practice address
1550 Highway 15 S Ste 29 Jackson KY 41339-9221
Fax: (606) 666-9982
Website:
Authorized official contact:
Name: Sartawi, Tariq A Doctor of Medicine (MD)

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 36227 Kentucky
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 36227 Kentucky

Profile Details

NPI number 1831225465
LBN Legal business name Jackson Ent Clinic , Psc
DBA Doing business as
Authorized official Sartawi, Tariq A Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 26th, 2007
Last updated Nov 14th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831225465 NPPES
Kentucky MEDICAID SA64023724

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