CENTRAL CLINIC, PC (NPI# 1649469743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649469743 |
| Entity Type | Organization |
| Organization Name | CENTRAL CLINIC, PC |
| Practice Address |
603 Lansing Ave Jackson MI 49202-3209 |
| Practice Telephone | 5177878371 |
| Practice Fax Number | 5177872639 |
| Mailing Telephone | 5177878371 |
| Mailing Fax Number | 5177872639 |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2010-09-27 |
| Authorized Official Name | DR. DAVID O OLADELE-BANKOLE (OWNER) |
| Authorized Official Telephone | 5177878371 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
4301042822 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 2833980 | 05 |
| Street Address |
603 LANSING AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49202-3209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588897987 | Home Healthcare Alliance, LLC | Home Health | 603 Lansing Ave, Ste. 106, Jackson, MI 49202-3209 | 2009-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821590316 | Leslie Dominique Barroso | Social Worker | 834 Kennedy St, Jackson, MI 49202 | 2018-03-01 |
| 1073011136 | Nicole Szarek | Social Worker | 1200 N. West Ave, Jackson, MI 49202 | 2018-01-24 |
| 1598299430 | Cedric Griffin | Behavior Technician | 950 W. Monroe St, Jackson, MI 49202 | 2017-04-18 |
| 1285081612 | Patricia Decker | Psychologist | 950 West Monroe, Suite 500, Jackson, MI 49202 | 2016-05-16 |
| 1619344314 | Erica Ries | Social Worker | 1200 N West Ave Ste 800, Jackson, MI 49202 | 2015-08-28 |
| 1184007189 | Sarah Johnson | Behavioral Analyst | 818 Winifred St, Jackson, MI 49202 | 2015-07-08 |
| 1871971697 | Scott A Watterson Dds, Pllc | Dentist | 1030 Laurence Ave, Suite 3, Jackson, MI 49202 | 2015-05-13 |
| 1043608680 | Brenda Beverly | Counselor | 1190 West, 1190 West Suite 812, Jackson, MI 49202 | 2015-01-06 |
| 1295091593 | Natalie Ann Kember | Social Worker | 1206 Clinton, Jackson, MI 49202 | 2012-04-11 |
| 1912218728 | Tina Marie Pierce | Respite Care | 225 N Wisner St, Jakson, MI 49202 | 2010-06-25 |
| Find all providers in zip 49202 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780713966 | Jackson Oncology Associates, Pllc | Internal Medicine | 1860 Chadwick Dr Ste 301, Jackson, MS 39204-3467 | 2007-03-05 |
| 1346379500 | Jackson Oncology Associates,pllc | Internal Medicine | 2969 Curran Dr N Ste 200, Jackson, MS 39216-4121 | 2007-03-05 |
| 1639119589 | Justin T Baker | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2006-06-08 |
| 1093779456 | Omar Ahmad | Internal Medicine | 36 Sandstone Cir, Suite A & B, Jackson, TN 38305-2098 | 2006-04-13 |
| 1235101437 | Gary G Shi | Internal Medicine | 617 New York Ranch Rd, Jackson, CA 95642-9328 | 2006-02-02 |
| 1144290032 | Brian N Walker | Internal Medicine | 322 Hospital Blvd, Jackson, TN 38305 | 2006-01-24 |
| 1740284389 | Van L Lackey | Internal Medicine | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2005-06-10 |
| 1407393374 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1740607225 | West Clinic, P.C. | Internal Medicine | 322 Hospital Blvd, Jackson, TN 38305-2079 | 2014-03-24 |
| 1205193570 | Eiran Avraham Warner | Internal Medicine | 205 N East Ave, Jackson, MI 49201-1753 | 2012-04-11 |
| 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.