Tommy Jackson (NPI# 1053324186, PAC ID# 9032003249) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1053324186 |
| PAC ID by PECOS | 9032003249 |
| Professional Enrollment ID | I20151229001659 |
| Full Name | Tommy Jackson |
| Organization Legal Name | FAIRBANKS MEMORIAL CARDIOLOGY CENTER, LLC |
| Address |
1650 Cowles St Fairbanks AK 99701-5907 |
| Phone Number | 9074586450 |
| Gender | M |
| Credential | PA |
| Graduation Year | 2003 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0244511269 |
| Number of Group Practice Members | 13 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 020012 | FAIRBANKS MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 3200 Providence Dr, Anchorage, AK 99508-4615 | 9075622211 | ALASKA RADIOLOGY ASSOCIATES INC |
| 1650 Cowles St, Fairbanks, AK 99701-5907 | 9074586450 | FAIRBANKS MEMORIAL CARDIOLOGY CENTER, LLC |
| Organization Legal Name | FAIRBANKS MEMORIAL CARDIOLOGY CENTER, LLC |
| Physicians | 13 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kaitlin M Roehl | Physician Assistant | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Theresa Calderon | Nurse Practitioner | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Lee Moschler Pierson | Cardiovascular Disease (cardiology) | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Romel C Wrenn | Cardiovascular Disease (cardiology) | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Debra M Triplehorn | Physician Assistant | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Dayna M Daku | Physician Assistant | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Gregory J Wood | Interventional Cardiology | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Milan Bajmoczi | Vascular Surgery | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Debra C Booysen | Nurse Practitioner | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Joseph D Grimes | Nurse Practitioner | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Street Address |
1650 COWLES ST |
| City | FAIRBANKS |
| State | AK |
| Zip | 99701-5907 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nicholas P Cosentino | Internal Medicine | Tanana Valley Clinic LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Manx D Quayle | Podiatry | 1650 Cowles St, Fairbanks, AK 99701-5907 | |
| Mark O Simon | Emergency Medicine | Golden Heart Emergency Physicians Inc | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Kaitlin M Roehl | Physician Assistant | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Theresa Calderon | Nurse Practitioner | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Andrew J Evanger | Pathology | Pathology Consultants Inc | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Margaret Rader | Certified Nurse Midwife (cnm) | Tanana Valley Clinic LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Terry A Conklin | Emergency Medicine | Golden Heart Emergency Physicians Inc | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Lee Moschler Pierson | Cardiovascular Disease (cardiology) | Fairbanks Memorial Cardiology Center, LLC | 1650 Cowles St, Fairbanks, AK 99701-5907 |
| Roy M Bak | Anesthesiology | Fairbanks Anesthesia Inc. | 1650 Cowles St, Wp100, Fairbanks, AK 99701-5998 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carol J Davis | Chiropractic | 1018 College Rd, Fairbanks, AK 99701-1557 | |
| William A Tewson | Chiropractic | 29 College Rd, 8b1, Fairbanks, AK 99701-1739 | |
| Virginia R Lind | Optometry | 59 College Rd, Suite 209, Fairbanks, AK 99701-1757 | |
| Aimee Desiree Burgess | Chiropractic | Life Sprout Chiropractic LLC | 505 Illinois St, Suite 4, Fairbanks, AK 99701-2946 |
| Jeremy Cole Fulk | Optometry | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| David J Peterson | Optometry | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| Damien R Delzer | Optometry | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| Stanley R Fuller | Ophthalmology | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| Natalie E Macke | Optometry | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| Rebecca S Wilbur | Optometry | Eye Clinic of Fairbanks Inc | 116 Minnie St, Fairbanks, AK 99701-3006 |
| Find all physicians in zip 99701 | |||
| City | FAIRBANKS |
| Zip Code | 99701 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | FAIRBANKS + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Tommy 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.