Provider Demographics
NPI:1013024603
Name:MT. JACKSON FAMILY HEALTH
Entity Type:Organization
Organization Name:MT. JACKSON FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-459-1111
Mailing Address - Street 1:5173 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MT. JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22664
Mailing Address - Country:US
Mailing Address - Phone:540-477-3808
Mailing Address - Fax:540-477-2719
Practice Address - Street 1:5173 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-9513
Practice Address - Country:US
Practice Address - Phone:540-477-3808
Practice Address - Fax:540-477-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty