Jackson, Thomas V

Jackson, Thomas V is an individual health care provider with primary practice located at 2817 New Pinery Rd Divine Savior Healthcare Inc, Portage WI 53901-9257. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Jackson, Thomas V can be contacted via phone (608) 742-4131.

Contact Information

Primary practice address
2817 New Pinery Rd Divine Savior Healthcare Inc Portage WI 53901-9257
Phone: (608) 742-4131
Fax: (608) 745-5173
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 21269020 Wisconsin

Profile Details

NPI number 1700862992
LBN Legal business name Jackson, Thomas V
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 20th, 2005
Last updated Jan 30th, 2012 - 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 1700862992 NPPES
Wisconsin MEDICAID 30128500

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