# INTEGRATED MEDICAL STAFF OF JACKSON PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JACKSON CLINIC, PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659779445
- **Legal business name:** JACKSON CLINIC, PA
- **Authorized official:** MR. MARK ALLEN (CEO)
- **Authorized official phone:** (731) 422-0330

## Contact information

- **Practice address:** 828 N PARKWAY, JACKSON, TN 38305-3032
- **Practice address phone:** (731) 422-0330
- **Practice address fax:** (731) 422-0499
- **Mailing address:** 828 N PARKWAY, JACKSON, TN 38305-3032
- **Mailing address phone:** (731) 422-0330
- **Mailing address fax:** (731) 422-0499

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RH0000X | Hematology (Internal Medicine) Physician | — | NULL | — |
| 207RH0000X | Hematology (Internal Medicine) Physician | — | — | — |
| 207RI0011X | Interventional Cardiology Physician | — | NULL | — |
| 207RI0011X | Interventional Cardiology Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |

## Other

- **Enumeration date:** 12/11/2014
- **Last updated:** 12/11/2014