GREG L JACKSON (NPI# 1063580843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063580843 |
| Entity Type | Organization |
| Organization Name | GREG L JACKSON |
| Other Organization Name | STAR MEDICAL SPECIALTIES |
| Practice Address |
4386 Sunbelt Dr Addison TX 75001 |
| Practice Telephone | 9723802065 |
| Practice Fax Number | 9723809488 |
| Mailing Telephone | 9723802065 |
| Mailing Fax Number | 9723809488 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2018-10-24 |
| Authorized Official Name | MR. GREG L JACKSON (CEO) |
| Authorized Official Telephone | 9723802065 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | MEDICAID CCP | 010118001 | 01 |
| TX | BLUE CROSS BLUE SHIELD | 0519596 | 01 |
| TX | 011564401 | 05 |
| Other Name | Type Code |
|---|---|
| Star Medical Specialties | Doing Business As Name - Organization |
| Street Address |
4386 SUNBELT DR |
| City | ADDISON |
| State | TX |
| Zip Code | 75001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538511910 | Star Formula Inc | Durable Medical Equipment & Medical Supplies | 4386 Sunbelt Dr, Addison, TX 75001-5611 | 2016-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073143772 | Naomi Grace Moats | Speech-Language Pathologist | 5820 Addison Rd, Addison, TX 75001 | 2020-01-22 |
| 1669020467 | Us Med, LLC | Durable Medical Equipment & Medical Supplies | 15455 Dallas Parkway, Suite 600; Office #6015, Addision, TX 75001 | 2019-08-27 |
| 1316592215 | Sunny Boy Pharmacy, LLC | Pharmacy | 4388 Sunbelt Dr, Addision, TX 75001 | 2019-08-07 |
| 1538714779 | Tarpon Pllc | Physical Medicine & Rehabilitation | 17051 N. Dallas Parkway, Suite 320, Addison, TX 75001 | 2019-08-05 |
| 1235782251 | Aliah T Green | Speech-Language Pathologist | 15820 Addison Road, Addison, TX 75001 | 2019-07-18 |
| 1902376254 | Kendall Leann Chambers | Counselor | 15851 Dallas Parkway, Suite 600, Addison, TX 75001 | 2018-11-29 |
| 1053800391 | U S Anesthesia Partners of Texas, Pa | Physician Assistant | 17051 Dallas Pkwy Ste 310, Addison, TX 75001 | 2018-05-02 |
| 1528561719 | Relinda Lee Longan | Licensed Vocational Nurse | 4820 Westgrove Dr, # 903, Addison, TX 75001 | 2018-03-14 |
| 1306363338 | Margaret Weiss | Social Worker | Steven A Cohen Military Family Clinic At Metrocare, 16160 Midway Rd, Suite 218, Addison, TX 75001 | 2017-08-30 |
| 1508380759 | Dallas Sci Recovery Inc | Clinic/Center | 15046 Beltway Dr, Addison, TX 75001 | 2017-07-31 |
| Find all providers in zip 75001 | ||||
| Taxonomy Code | 332BP3500X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Parenteral & Enteral Nutrition |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801405717 | Tcg Interests, LLC | Durable Medical Equipment & Medical Supplies | 11420 Ferrell Dr Ste 309, Farmers Branch, TX 75234-9422 | 2020-07-27 |
| 1194349589 | Cjand Medical Equipment and Supplies | Durable Medical Equipment & Medical Supplies | 12315 Bellaire Blvd Ste 800, Houston, TX 77072-2557 | 2020-06-02 |
| 1326520206 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 5627 University Heights, Ste. 105, San Antonio, TX 78249 | 2018-09-06 |
| 1235626615 | Texas Health Presbyterian Hospital Dallas | Durable Medical Equipment & Medical Supplies | 8160 Walnut Hill Lane, First Floor, Dallas, TX 75231 | 2018-04-20 |
| 1780187237 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 8888 Interchange Dr Rm 119, Houston, TX 77054-2512 | 2018-03-12 |
| 1477061554 | Patient Solutions LLC | Durable Medical Equipment & Medical Supplies | 2149 Del Rio Blvd Ste 206, Eagle Pass, TX 78852-3487 | 2018-01-11 |
| 1902313463 | Iv Rx Inc | Durable Medical Equipment & Medical Supplies | 10119 Broadway St, San Antonio, TX 78217-4420 | 2018-01-05 |
| 1295254365 | Medical Billing & Equipment of Texas LLC | Durable Medical Equipment & Medical Supplies | 402 E Hillside Rd Ste 3, Laredo, TX 78041-3292 | 2017-09-11 |
| 1568900421 | Shield Healthcare Tx, Inc. | Durable Medical Equipment & Medical Supplies | 5212 Tennyson Pkwy Suite 400, Plano, TX 75024-4211 | 2017-02-10 |
| 1225489578 | Medco Respiratory Instruments, Inc | Durable Medical Equipment & Medical Supplies | 10630 Newkirk St Ste 100, Dallas, TX 75220-2334 | 2016-06-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.