Provider Demographics
NPI:1407100274
Name:JACKSON MEDICAL PRODUCTS, LLC
Entity Type:Organization
Organization Name:JACKSON MEDICAL PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-517-5350
Mailing Address - Street 1:77 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-1237
Mailing Address - Country:US
Mailing Address - Phone:877-453-3531
Mailing Address - Fax:855-453-3541
Practice Address - Street 1:77 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-1237
Practice Address - Country:US
Practice Address - Phone:877-453-3531
Practice Address - Fax:855-453-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0511759332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies