Jackson, Thomas Miles

Jackson, Thomas Miles is an individual health care provider with primary practice located at 2201 San Juan Ave , La Junta CO 81050-3323. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Jackson, Thomas Miles can be contacted via phone (719) 384-8181.

Contact Information

Primary practice address
2201 San Juan Ave La Junta CO 81050-3323
Phone: (719) 384-8181
Fax: (719) 384-4872
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 04-21320 Kansas
Allopathic & Osteopathic Physicians / Surgery 208600000X 5568 Alaska
Allopathic & Osteopathic Physicians / Surgery 208600000X DR48817 Colorado

Profile Details

NPI number 1598765083
LBN Legal business name Jackson, Thomas Miles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated May 12th, 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 1598765083 NPPES
Kansas MEDICAID 100131110B

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