Provider Demographics
NPI:1063525525
Name:JACKSON MED TECHS
Entity type:Organization
Organization Name:JACKSON MED TECHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-624-1318
Mailing Address - Street 1:PO BOX 320531
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0531
Mailing Address - Country:US
Mailing Address - Phone:601-362-6898
Mailing Address - Fax:
Practice Address - Street 1:2080 DUNBARTON DR
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5016
Practice Address - Country:US
Practice Address - Phone:601-624-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare