Organization
JACKSON SURGICAL ASSOCIATES. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY WEBSTER (OFFICE MANAGER)
(731) 664-7395
Entity
Organization
Contact information
Practice address
395 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 664-7395
(731) 664-0057
Mailing address
395 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 664-7395
(731) 664-0057
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9997
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107276
BLUE CROSS
TN
01
—
1356346142
NPI
TN
01
—
1376548503
NPI
TN
01
—
1609871821
NPI
TN
05
—
3053968
—
TN
01
—
3060477
BLUE CROSS
TN
05
—
3089277
—
TN
05
—
3862742
—
TN
01
—
4005486
BLUE CROSS
TN
Enumeration date
05/23/2006
Last updated
10/22/2007
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