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MARK A JACKSON MD PLC NPI 1740439025


NPI Information

NPI: 1740439025
Provider Name: MARK A JACKSON MD PLC
Classification: Family Medicine - 207QG0300X
Entity Type: Organization

Specialization: Geriatric Medicine

Address:
1000 PAVILLIONS CIR
TRAVERSE CITY, MI
ZIP 49684
Phone: (231) 935-0913
Get Directions

MARK A JACKSON MD PLC is a geriatric medicine family medicine in Traverse City, MI. The provider is a family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. MARK A JACKSON MD PLC NPI is 1740439025. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1000 PAVILLIONS CIR
TRAVERSE CITY, MI
ZIP 49684-198
Phone: (231) 935-0913
Fax: (231) 935-0984

The provider's authorized official is Mark A Jackson .
The authorized official title is Physician/owner and has the following contact phone number (231) 935-0913.

The enumeration date for this NPI number is 9/11/2008 and was last updated on 12/18/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QG0300XFamily MedicineGeriatric Medicine4301051555MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1080B813500OTHERMICHIGANBCBS ID#
20B81350OTHERMICHIGANBCBS GROUP ID#
3MI1114001OTHERMICHIGANMEDICARE IND PTAN
41073585238MEDICAIDMICHIGAN
50802802421OTHERMICHIGANBCBS PIN#
61740439025OTHERMICHIGANGROUP NPI
7B43877MEDICARE UPINMICHIGAN
80MI1114001MEDICARE PINMICHIGAN
90MI1114OTHERMICHIGANMEDICARE GROUP
10MI1114MEDICARE PINMICHIGAN
111073585238OTHERMICHIGANIND NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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