Provider Demographics
NPI:1841200722
Name:JACKSON CARDIOLOGY & ASSOCIATES
Entity Type:Organization
Organization Name:JACKSON CARDIOLOGY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-3577
Mailing Address - Street 1:205 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-787-3577
Mailing Address - Fax:517-787-4280
Practice Address - Street 1:205 PAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-787-3577
Practice Address - Fax:517-787-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty