Provider Demographics
NPI:1912378977
Name:THE JACKSON CLINICS LP
Entity Type:Organization
Organization Name:THE JACKSON CLINICS LP
Other - Org Name:THE JACKSON CLINICS LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-687-8181
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:
Practice Address - Street 1:119 THE PLAINS ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20118
Practice Address - Country:US
Practice Address - Phone:540-687-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USPH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty