Individual
JAMES W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
630 BROADWAY ST, MADISON, IN 47250-3310
(812) 265-0820
(812) 265-0570
Mailing address
PO BOX 189, MADISON, IN 47250-0189
(812) 265-0820
(812) 265-0570
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01021515
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210998
ANTHEM BCBS
IN
01
—
060055388
MEDICARE RAILROAD
—
01
—
1096355
PASSPORT KY MEDICAID
KY
05
—
200149120A
—
IN
01
—
2436127000
PASSPORT ADVANTAGE
KY
01
—
5412546
AETNA
—
05
—
64337330
—
KY
Enumeration date
06/28/2006
Last updated
04/22/2008
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