Organization
JACKSON MEDICAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JILL CHAMBERS (OFFICE MANAGER)
(304) 372-3506
Entity
Organization
Contact information
Practice address
122 PINNELL STREET, RIPLEY, WV 25271
(304) 372-3506
(304) 372-3523
Mailing address
PO BOX 171, RIPLEY, WV 25271-0171
(304) 372-3506
(304) 372-3523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1524
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722717
BLUE CROSS BLUE SHIELD
WV
05
—
0203269000
—
WV
Enumeration date
04/11/2007
Last updated
11/01/2011
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