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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154308997 NPPES
Indiana Other 01046379A STATE LICENSE NUMBER
Indiana MEDICAID 200134430B STATE LICENSE NUMBER

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