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Organization

JACKSON FAMILY CLINIC, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KENNETT D ASHER DO (OWNER)
(573) 243-8408
Entity
Organization

Contact information

Practice address
545 BROADRIDGE, JACKSON, MO 63755
(573) 243-8408
(573) 243-0445
Mailing address
545 BROADRIDGE, JACKSON, MO 63755
(573) 243-8408
(573) 243-0445

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
505190207
MO
01
CO9028
RR MEDICARE
MO
Enumeration date
03/19/2007
Last updated
04/29/2008
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