Jackson Primary Care LLC

NPI #1790213676 in Jackson, Missouri

Provider Information

NPI Number: 1790213676
Entity Type: Organization
Organization Name: Jackson Primary Care LLC
Primary Specialty: Clinic/Center - Primary Care
Enumeration Date: May 23, 2017
Last Updated: May 25, 2017

Practice Location

Address: 2685 E MAIN ST STE A
City: Jackson
State: Missouri
ZIP Code: 63755-2474
Phone: (573) 204-1400

Authorized Official

Name: JOAN L MAYBERRY
Title: OFFICE MANAGER
Phone: (573) 204-1400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Rural Health — Rural Health	261QR1300X
Clinic/Center - Primary Care — Primary Care	261QP2300X	Primary

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