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Organization

JACKSON HEALTH AND THEATER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL JACKSON (MEMBER)
(702) 326-2149
Entity
Organization

Contact information

Practice address
360 SOUTH LOLA LANE, PAHRUMP, NV 89048
(775) 751-7833
Mailing address
11103 KILKERRAN CT, LAS VEGAS, NV 89141-4356
(702) 326-2149

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10306
NV

Other

Enumeration date
06/09/2006
Last updated
09/21/2007
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