Jackson, Thomas L
Jackson, Thomas L is an sole proprietor health care provider with primary practice located at 2450 N Park Dr , Columbus IN 47203-2216. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jackson, Thomas L can be contacted via phone (812) 376-8997.Contact Information
Primary practice address
2450 N Park Dr
Columbus IN 47203-2216
Phone: (812) 376-8997
Fax: (812) 373-5323
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 01046379A | Indiana |
Profile Details
| NPI number | 1154308997 |
|---|---|
| LBN Legal business name | Jackson, Thomas L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 22nd, 2005 |
| Last updated | Aug 2nd, 2010 - about 16 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 | 1154308997 | NPPES |
| Indiana | Other | 01046379A | STATE LICENSE NUMBER |
| Indiana | MEDICAID | 200134430B | STATE LICENSE NUMBER |
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