Provider Demographics
NPI:1881197861
Name:O.B. JACKSON INC
Entity Type:Organization
Organization Name:O.B. JACKSON INC
Other - Org Name:JACKSON'S FURNITURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-332-6721
Mailing Address - Street 1:14001 HIGHWAY 43 STE 15
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2849
Mailing Address - Country:US
Mailing Address - Phone:256-332-6721
Mailing Address - Fax:
Practice Address - Street 1:14001 HIGHWAY 43 STE 15
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2849
Practice Address - Country:US
Practice Address - Phone:256-332-6721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No305S00000XManaged Care OrganizationsPoint of Service