Jackson Family Clinic

LBN: Jackson Medical Clinic, Pc
Jackson Family Clinic is an health care organization with primary practice located at 410 E Cherokee St , Wagoner OK 74467-4708. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as the primary health care specialty. Jackson Medical Clinic, Pc can be contacted via phone (918) 485-5591, or through Haley, Kelly Noel via phone (918) 485-5591.

Contact Information

Primary practice address
410 E Cherokee St Wagoner OK 74467-4708
Phone: (918) 485-5591
Fax: (918) 485-5758
Website:
Map and Directions
Authorized official contact:
Name: Haley, Kelly Noel
Phone: (918) 485-5591

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 28153 Oklahoma

Profile Details

NPI number 1457594699
LBN Legal business name Jackson Medical Clinic, Pc
DBA Doing business as Jackson Family Clinic
Authorized official Haley, Kelly Noel
Entity Organization
Organization subpart 1 No
Enumeration date Apr 17th, 2009
Last updated Mar 22nd, 2017 - about 9 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 1457594699 NPPES
Oklahoma MEDICAID 100141080E

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