Jackson, James W
Jackson, James W is an individual health care provider with primary practice located at 120 Executive Park , Louisville KY 40207. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Jackson, James W can be contacted via phone (502) 855-7200.Contact Information
Primary practice address
120 Executive Park
Louisville KY 40207
Phone: (502) 855-7200
Fax: (502) 855-7201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 01062749A | Indiana |
| Allopathic & Osteopathic Physicians / Interventional Pain Medicine | 208VP0014X | 41100 | Kentucky |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 41100 | Kentucky |
Profile Details
| NPI number | 1063583268 |
|---|---|
| LBN Legal business name | Jackson, James W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 11th, 2006 |
| Last updated | Jun 9th, 2022 - about 3 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 | 1063583268 | NPPES |
| Kentucky | Other | 719905 | WELLCARE OF KY PROVIDER ID |
| Kentucky | Other | 002903176 | WELLCARE OF KY PROVIDER ID |
| Kentucky | Other | 9121168 | WELLCARE OF KY PROVIDER ID |
| Kentucky | MEDICAID | 200872860 | WELLCARE OF KY PROVIDER ID |
| Kentucky | Other | 000000858929 | WELLCARE OF KY PROVIDER ID |
| Kentucky | MEDICAID | 7100003940 | WELLCARE OF KY PROVIDER ID |
| Kentucky | Other | CS1434500725 | WELLCARE OF KY PROVIDER ID |
| Kentucky | Other | 135386KYIP | WELLCARE OF KY PROVIDER ID |
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