INTERNAL MEDICINE CLINIC OF JACKSON PLLC (NPI# 1174773428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174773428 |
| Entity Type | Organization |
| Organization Name | INTERNAL MEDICINE CLINIC OF JACKSON PLLC |
| Practice Address |
587 Skyline Dr Jackson TN 38301-3938 |
| Mailing Address |
3 Windwood Dr Jackson TN 38305-8835 |
| Practice Telephone | 7314248922 |
| Practice Fax Number | 7314232922 |
| Mailing Telephone | 7316689031 |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-25 |
| Authorized Official Name | ROBERT HUDSON DUNNEBACKE (PLLC MEMBER) |
| Authorized Official Telephone | 7316689031 |
| Authorized Official Credential | M.D, |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
MD011299 | TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3182200 | 05 |
| Street Address |
587 SKYLINE DR |
| City | JACKSON |
| State | TN |
| Zip Code | 38301-3938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043437130 | The Medical Clinic of Jackson | Internal Medicine | 587 Skyline Dr, Jackson, TN 38301-3911 | 2007-04-19 |
| 1245890052 | Somer Lambert | Nurse Practitioner | 587 Skyline Dr, Jackson, TN 38301-3938 | 2019-06-14 |
| 1194285189 | Katie Alyse Johnson | Nurse Practitioner | 587 Skyline Dr, Jackson, TN 38301-3938 | 2019-03-25 |
| 1407351794 | Mimi Dill | Nurse Practitioner | 587 Skyline Dr, Jackson, TN 38301-3938 | 2018-03-28 |
| 1871983452 | Jaclyn Bane | Nurse Practitioner | 587 Skyline Dr, Jackson, TN 38301-3938 | 2015-02-03 |
| 1215175278 | Stacie K Grantham | Nurse Practitioner | 587 Skyline Dr, Jackson, TN 38301-3938 | 2009-01-29 |
| 1629295738 | Robert H Dunnebacke | Internal Medicine | 587 Skyline Dr, Jackson, TN 38301-3911 | 2007-04-19 |
| 1235356361 | Conrado B Sioson Jr. | Internal Medicine | 587 Skyline Dr, Jackson, TN 38301-3911 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124634696 | Lindsey Crowder | Social Worker | 127 Mccowat Street, Jackson, TN 38301 | 2020-09-21 |
| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1629592522 | Tlc Home Care Services, LLC | In Home Supportive Care | 39 Old Denmark Rd, Jackson, TN 38301 | 2017-08-01 |
| 1841730421 | Southern Hands Quality Care | In Home Supportive Care | 1298 N. Highland Avenue. Suite 14, Jackson, TN 38301 | 2017-03-02 |
| 1881044477 | Katie Mcmickin | Counselor | 163 Sunnyside Dr, Jackson, TN 38301 | 2016-06-15 |
| 1164815064 | Hailey Archer | Dietitian, Registered | 720 W. Forest Ave., Jackson, TN 38301 | 2015-03-17 |
| 1740673714 | Regina Tignor | Nurse Practitioner | 1410 Us Highway 70 Byp, Jackson, TN 38301 | 2015-03-13 |
| 1194114033 | Woman's Clinic | Obstetrics & Gynecology | 242 Coatsland, Jackson, TN 38301 | 2015-01-15 |
| 1659797702 | Worthy Walker Arrington | Nurse Practitioner | 720 West Forest Avenue, Jackson, TN 38301 | 2014-03-13 |
| 1669717302 | Lift Wellness Inc | General Practice | 101 Jackson Walk Plaza, Jackson, TN 38301 | 2012-12-06 |
| Find all providers in zip 38301 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1114427507 | Advance Care, LLC | Clinic/Center | 14 Northtown Dr Ste 105, Jackson, MS 39211-3018 | 2018-02-13 |
| 1467841742 | Dc Medical Services Inc | Clinic/Center | 7 Stonebridge Blvd Ste C, Jackson, TN 38305-2049 | 2015-01-09 |
| 1558779728 | Rural Health Group, Inc. | Clinic/Center | 9742 Nc Highway 305, Jackson, NC 27845-9799 | 2014-07-31 |
| 1043573199 | Fondren Medical Clinic | Clinic/Center | 4436 N State St, Suite A-1, Jackson, MS 39206-5334 | 2012-06-22 |
| 1043503832 | Mid Jackson Family Health Clinic | Clinic/Center | 514c Woodrow Wilson Dr, Jackson, MS 39216 | 2011-05-26 |
| 1053646190 | More Convenient Care Center LLC | Clinic/Center | 4612 Medgar Evers Blvd, Suite 10, Jackson, MS 39213-5205 | 2009-10-07 |
| 1518121326 | University Nursing Associates Pllc | Clinic/Center | 136 W Ash St, Jackson, MS 39202-2217 | 2008-07-11 |
| 1114194347 | Community Action Committee of Pike County | Clinic/Center | 14590 St Rt 93, Family Health Center Jackson, Jackson, OH 45640 | 2008-05-16 |
| Find all providers in JACKSON | ||||
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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.