Jacob I Jackson (NPI# 1861832644, PAC ID# 2264743400) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1861832644 |
| PAC ID by PECOS | 2264743400 |
| Professional Enrollment ID | I20150615002389 |
| Full Name | Jacob I Jackson |
| Organization Legal Name | NORTHEAST MISSOURI MEDICAL PROVIDERS LLC |
| Address |
2305 Georgia St Louisiana MO 63353-2559 |
| Phone Number | 5737545531 |
| Gender | M |
| Graduation Year | 2013 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 2466740402 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140289 | ANDERSON HOSPITAL |
| 261333 | PIKE COUNTY MEMORIAL HOSPITAL |
| 141306 | COMMUNITY MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2305 Georgia St, Louisiana, MO 63353-2559 | 5737545531 | NORTHEAST MISSOURI MEDICAL PROVIDERS LLC |
| Organization Legal Name | NORTHEAST MISSOURI MEDICAL PROVIDERS LLC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert S Bridge | Internal Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Laurel L Baumstark | Family Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Stanislav T Merka | Emergency Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Brian K Brown | Emergency Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Street Address |
2305 GEORGIA ST |
| City | LOUISIANA |
| State | MO |
| Zip | 63353-2559 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert S Bridge | Internal Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Laurel L Baumstark | Family Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Stanislav T Merka | Emergency Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Brian K Brown | Emergency Medicine | Northeast Missouri Medical Providers LLC | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Phillip W Pitney | Family Medicine | Hannibal Regional Healthcare System Inc | 2305 Georgia St, Louisiana, MO 63353-2559 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Eric Todd Gearing | Chiropractic | 122 S 3rd St, Louisiana, MO 63353-2060 | |
| Aaron T Miller | Family Medicine | Pike County Memorial Hospital | 2305 W Georgia, Louisiana, MO 63353-2559 |
| Casey A Jennings | Family Medicine | Pike County Memorial Hospital | 2305 W Georgia, Louisiana, MO 63353-2559 |
| Tarrah Hickerson | Clinical Social Worker | Pike County Memorial Hospital | 2305 W Georgia, Louisiana, MO 63353-2559 |
| Sharon G Harris | Endocrinology | Pike County Memorial Hospital | 2305 W Georgia, Louisiana, MO 63353-2559 |
| Cole J Scherder | Family Practice | Pike County Memorial Hospital | 2305 W Georgia, Louisiana, MO 63353-2559 |
| City | LOUISIANA |
| Zip Code | 63353 |
| Specialty | GENERAL SURGERY |
| City + Specialty | LOUISIANA + GENERAL SURGERY |
Please comment or provide details below to improve the information on Jacob I Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.