# JACKSON HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639359565
- **Authorized official:** DR. WILLIAM J JACKSON MD (OWNER/DOCTOR)
- **Authorized official phone:** (502) 647-1958

## Contact information

- **Practice address:** 148 MIDLAND BLVD, SHELBYVILLE, KY 40065-9734
- **Practice address phone:** (502) 647-1958
- **Practice address fax:** (502) 647-1940
- **Mailing address:** 148 MIDLAND BLVD, SHELBYVILLE, KY 40065-9734
- **Mailing address phone:** (502) 647-1958
- **Mailing address fax:** (502) 647-1940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 18425 | KY | Yes |

## Other

- **Enumeration date:** 11/08/2007
- **Last updated:** 11/08/2007