Jackson, Jay A

Jackson, Jay A is an individual health care provider with primary practice located at 9119 W 74Th St Suite 350, Shawnee Mission KS 66204-2215. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Jackson, Jay A can be contacted via phone (913) 789-3290.

Contact Information

Primary practice address
9119 W 74Th St Suite 350 Shawnee Mission KS 66204-2215
Phone: (913) 789-3290
Fax: (913) 789-3208
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X R8D86 Missouri

Profile Details

NPI number 1558360743
LBN Legal business name Jackson, Jay A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Sep 11th, 2013 - about 12 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 1558360743 NPPES
Missouri MEDICAID 1558360743
Missouri MEDICAID 201986726
Missouri MEDICAID 100168130J

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