Organization
JACKSON ENT CLINIC , PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARIQ A SARTAWI M.D. (OWNER)
(606) 666-9909
Entity
Organization
Contact information
Practice address
1550 HIGHWAY 15 S STE 29, JACKSON, KY 41339-9221
(606) 666-9909
(606) 666-9982
Mailing address
PO BOX 768, JACKSON, KY 41339-0768
(606) 666-9909
(606) 666-9982
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
36227
KY
207Y00000X
Otolaryngology Physician
Primary
36227
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA64023724
—
KY
Enumeration date
02/26/2007
Last updated
11/14/2008
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