MATTHAN JACKSON (NPI# 1194170571) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194170571 |
| Entity Type | Individual |
| Full Name | MATTHAN JACKSON |
| Credential | DO |
| Practice Address |
527 Medical Park Dr Ste 500 Bridgeport WV 26330-9008 |
| Practice Telephone | 6813423600 |
| Practice Fax Number | 6813423625 |
| Mailing Telephone | 6813423600 |
| Mailing Fax Number | 6813423625 |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2019-06-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 3347 | WV | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Amalia Dr, Buckhannon, WV 262012239 | 3044732000 |
| Street Address |
527 MEDICAL PARK DR STE 500 |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330-9008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134101660 | United Hospital Center Inc | Family Medicine | 527 Medical Park Dr, Suite 500, Bridgeport, WV 26330-9010 | 2005-11-18 |
| 1760967400 | Susan Rennae Kirkendall | Counselor | 527 Medical Park Dr, Bridgeport, WV 26330-9008 | 2018-09-28 |
| 1457886988 | Rachel S Holeman | Student in an Organized Health Care Education/Training Program | 527 Medical Park Dr, Suite 500, Bridgeport, WV 26330-9008 | 2017-04-21 |
| 1205360237 | Nathan E Russell | Student in an Organized Health Care Education/Training Program | 527 Medical Park Dr, Suite 500, Bridgeport, WV 26330-9008 | 2017-04-17 |
| 1255865275 | Brandon M Lewko | Emergency Medicine | 527 Medical Park Dr, Suite 500, Bridgeport, WV 26330-9008 | 2017-04-17 |
| 1144754177 | Premkumar Chandrakantbhai Patel | General Practice | 527 Medical Park Dr, Suite 500, Bridgeport, WV 26330-9008 | 2017-04-17 |
| 1922546175 | Leslie D. Mavromatis | Counselor | 527 Medical Park Dr, Bridgeport, WV 26330-9008 | 2017-02-08 |
| 1316491996 | Ellen Palmer Hoban | Nurse Practitioner | 527 Medical Park Dr, Suite 105, Bridgeport, WV 26330-9008 | 2016-08-11 |
| 1447605837 | Arsalan Khawaja | Student in an Organized Health Care Education/Training Program | 527 Medical Park Dr, Ste 500, Bridgeport, WV 26330-9008 | 2016-05-04 |
| 1902251374 | Kristin Black | Student in an Organized Health Care Education/Training Program | 527 Medical Park Dr, Ste 500, Bridgeport, WV 26330-9008 | 2016-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780158287 | Rejuvenation Medspa | Family Medicine | 1400 Johnson Ave Ste 4a, Bridgeport, WV 26330-1063 | 2019-01-17 |
| 1497244321 | Sanitas of Connecticut LLC | Family Medicine | 4551 Main St, Bridgeport, CT 06606-1818 | 2018-05-07 |
| 1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
| 1013395755 | Clinisanitas, PC | Family Medicine | 4543 Main St, Bridgeport, CT 06606-1818 | 2015-05-14 |
| 1982941431 | Razia Sultana Hashmi | Family Medicine | 115 Highland Ave, Bridgeport, CT 06604-3549 | 2013-01-03 |
| 1508025594 | Awais Malik | Family Medicine | 754 Clinton Ave, Bridgeport, CT 06604-2301 | 2008-06-04 |
| 1508062423 | Bridgeport Family Practice Obgyn Clinic | Family Medicine | 615 Kendall Ave, Bridgeport, AL 35740 | 2007-06-26 |
| 1760505887 | Vinai Montricul | Family Medicine | 47910 Al Highway 277, Bridgeport, AL 35740-7206 | 2007-04-06 |
| 1942341060 | Zijad Sabovic | Family Medicine | 3000 Park Ave, Bridgeport, CT 06604-1105 | 2007-02-09 |
| 1538207295 | Bridgeport Family Health LLC | Family Medicine | 1381 Reservoir Avenue, Bridgeport, CT 06606-2502 | 2007-02-02 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
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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.