Jason W Thackeray Md Pa
LBN: Jason W Thackeray Md Pa
Jason W Thackeray Md Pa is an health care organization with primary practice located at 1034 Mar Walt Dr Ste 100 , Fort Walton Beach FL 32547-6645. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as the primary health care specialty.
Jason W Thackeray Md Pa can be contacted via phone (850) 863-2153, or through Thackeray, Jason W via phone (850) 863-2153.
Contact Information
Primary practice address
1034 Mar Walt Dr Ste 100
Fort Walton Beach FL 32547-6645
Phone: (850) 863-2153
Fax: (850) 315-9350
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | ME77615 | Florida |
Profile Details
| NPI number | 1568504173 |
|---|---|
| LBN Legal business name | Jason W Thackeray Md Pa |
| DBA Doing business as | |
| Authorized official | Thackeray, Jason W Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 12th, 2007 |
| Last updated | Oct 29th, 2020 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568504173 | NPPES |
| Florida | Other | 17147 | BS PROVIDER NUMBER |
| Florida | MEDICAID | 265809700 | BS PROVIDER NUMBER |
| Florida | Other | 1568504173 | BS PROVIDER NUMBER |
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