Provider Demographics
NPI:1427331735
Name:JACKSON, LILLIE R
Entity type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:R
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112087
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-2087
Mailing Address - Country:US
Mailing Address - Phone:832-265-5753
Mailing Address - Fax:281-448-0768
Practice Address - Street 1:600 KENRICK DR STE C26
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3698
Practice Address - Country:US
Practice Address - Phone:832-265-5753
Practice Address - Fax:281-448-0768
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport