Provider Demographics
NPI:1508994211
Name:JACKSON & BIGELOW MD PC
Entity Type:Organization
Organization Name:JACKSON & BIGELOW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-631-2020
Mailing Address - Street 1:400 JOSEPH DR STE B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8636
Mailing Address - Country:US
Mailing Address - Phone:989-631-2020
Mailing Address - Fax:989-835-6686
Practice Address - Street 1:400 JOSEPH DR STE B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8636
Practice Address - Country:US
Practice Address - Phone:989-631-2020
Practice Address - Fax:989-835-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207W00000X
MI4301050635174400000X
MI4301056492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104430921Medicaid
MI0256160001OtherDMERC
MI103085182Medicaid
MI180E645300OtherBCBS GROUP NUMBER
MI103103914Medicaid
MICN3193OtherRAILROAD MEDICARE
MI104430959Medicaid
MI180E645300OtherBLUE CROSS BLUE SHIELD
MIE645304182Medicare PIN
MI180E645300OtherBCBS GROUP NUMBER
MICN3193OtherRAILROAD MEDICARE
MI0256160001OtherDMERC
MI0256160001Medicare NSC