Organization
JACKSON PEG TUBE STANDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JACKSON (PRESIDENT)
(606) 638-3234
Entity
Organization
Contact information
Practice address
322 S JEFFERSON ST, LOUISA, KY 41230-1316
(606) 638-3234
Mailing address
322 S JEFFERSON ST, LOUISA, KY 41230-1316
(606) 638-3234
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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