JACKSON ENT CLINIC , PSC


Address: 1550 Highway 15 S Ste 29, Jackson, KY 41339-9221
Phone: 6066669909

JACKSON ENT CLINIC , PSC (NPI# 1831225465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1831225465
Entity Type Organization
Organization Name JACKSON ENT CLINIC , PSC
Practice Address 1550 Highway 15 S Ste 29
Jackson
KY 41339-9221
Mailing Address Po Box 768
Jackson
KY 41339-0768
Practice Telephone 6066669909
Practice Fax Number 6066669982
Mailing Telephone 6066669909
Mailing Fax Number 6066669982
Enumeration Date 2007-02-26
Last Update Date 2008-11-14
Authorized Official Name DR. TARIQ A SARTAWI (OWNER)
Authorized Official Telephone 6066669909
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 204E00000X Oral & Maxillofacial Surgery 36227 KY Allopathic & Osteopathic Physicians
Y 207Y00000X Otolaryngology 36227 KY Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
KY SA64023724 05

Office Location

Street Address 1550 HIGHWAY 15 S STE 29
City JACKSON
State KY
Zip Code 41339-9221

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841890662 Angela Shawn Bradley Pharmacist 1589 Ky Hwy 15 South, Jackson, KY 41339 2020-10-30
1871191734 Ranita Greer Pharmacist 59 Ky-15 N, Jackson, KY 41339 2020-10-13
1336763135 Jill Elaine Beattie Green Occupational Therapist 100 Ky-15, Jackson, KY 41339 2020-06-08
1023641446 Andreanna Gibbs Physical Therapy Assistant 100 Hwy 15, Jackson, KY 41339 2020-02-13
1144797754 Visionary Rehabilitation Services, LLC Speech-Language Pathologist 100 Kentucky Hwy 15 South, Suite 136, Jackson, KY 41339 2018-11-01
1477081206 Trending Upwards Counselor 1754 Highway 15 N, Jackson, KY 41339 2017-05-24
1508225996 Jessica Williams Pharmacist 842 Highway 15 N, Jackson, KY 41339 2016-02-15
1245637255 Breathitt County Ambulance, Inc. Ambulance 440 Highway 1812 North, Jackson, KY 41339 2014-11-20
1265784045 Jonathan Charles Morris Physical Therapist 695 Ky Hwy 15 N, Ste 3, Jackson, KY 41339 2012-10-04
1649539958 Henry Price Sewell IIi IIi Family Medicine 170 Picnic Hill Rd, Jackson, KY 41339 2012-05-07
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Taxonomy Information

Taxonomy Code 207Y00000X
Grouping Allopathic & Osteopathic Physicians
Classification Otolaryngology

Taxonomy Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1255878062 W.a. Foote Memorial Hospital, Inc Otolaryngology 205 N.east Ave, Jackson, MI 49201 2017-01-31
1194973941 Howard B Cheek Otolaryngology 4080 Boxwood Circle, Jackson, MS 39211-6609 2008-09-05
1881712057 Ear Nose & Throat Surgical Group Otolaryngology 764 Lakeland Drive, Suite 200, Jackson, MS 39216-4617 2007-03-27
1811076938 Kyle Ford Gordon Otolaryngology 970 Lakeland Dr Ste 40, Jackson, MS 39216-4640 2006-11-02
1285713305 Andrew Byron Brown IIi Otolaryngology 764 Lakeland Dr Ste 200, Jackson, MS 39216-4617 2006-11-02
1780771956 Tammy Sanders Otolaryngology 1500 E. Woodrow Wilson Ave., Jackson, MS 39216-5199 2006-10-06
1922097492 Stephen L Kirkner Otolaryngology 1111 Teneyck St, Suite 100, Jackson, MI 49201-2461 2005-10-18
1720070535 West Tennessee Ent Clinic, P.a. Otolaryngology 619 Skyline Dr, Jackson, TN 38301-3903 2005-08-17
1245795400 Dr. Patricia A Murphy Pllc Otolaryngology 221 Highway 15 S, Jackson, KY 41339-9600 2019-02-01
1336677624 Wendy Nicole Marino Otolaryngology 764 Lakeland Dr, Jackson, MS 39216-4651 2017-05-31
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City JACKSON
Zip Code 41339

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Dataset Information

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.

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