IRVIN CHARLES JACKSON (NPI# 1851903264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851903264 |
| Entity Type | Individual |
| Full Name | IRVIN CHARLES JACKSON |
| Practice Address |
327 East Street Shubuta MS 39360 |
| Mailing Address |
Po Box 62 Shubuta MS 39360-0062 |
| Practice Telephone | 6015774018 |
| Mailing Telephone | 6015774018 |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2020-09-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 343900000X | Non-emergency Medical Transport (VAN) | Transportation Services | ||
| N | 343900000X | Non-emergency Medical Transport (VAN) | 8006822128 | MS | Transportation Services |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184066631 | Irvin Travis Jackson Jr. | Pharmacist | 4720 Dollarway Rd, Pine Bluff, AR 71602-4126 | 2013-07-25 |
| Street Address |
327 EAST STREET |
| City | SHUBUTA |
| State | MS |
| Zip Code | 39360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053882415 | Debra Eloise Bender | Non-emergency Medical Transport (VAN) | 6320 County Road 610, Shubuta, MS 39360 | 2018-12-11 |
| 1376727388 | Jacquenett Jackson | Custodial Care Facility | 114 Second Street, Shubuta, MS 39360 | 2007-12-27 |
| 1457477481 | Virgie C Wade | Nurse Practitioner | 130 North High St, Shubuta, MS 39360 | 2007-03-21 |
| 1548359565 | Outreach Health Services,inc. | Clinic/Center | 130 North High Street, Shubuta, MS 39360 | 2006-10-11 |
| 1568095453 | Robert William Dycus | Nurse Practitioner | 130 N. High Street, Shubuta, MS 39360-3936 | 2020-02-19 |
| 1568644383 | Superior Home Care | Early Intervention Provider Agency | 130 County Road 2700, Shubuta, MS 39360-8600 | 2007-12-04 |
| 1881921682 | Superior Home Care | Respite Care | 130 County Road 2700, Shubuta, MS 39360-8600 | 2009-11-16 |
| 1912903766 | Karen Parker | Nurse Practitioner | 130n High St, Shubuta, MS 39360-8870 | 2005-06-27 |
| 1578920328 | Shanika Boyd | Nurse Practitioner | 130 N High St, Shubuta, MS 39360-8870 | 2016-01-25 |
| 1811367048 | Patricia Simpson | Nurse Practitioner | 130 N High St, Shubuta, MS 39360-8870 | 2015-09-30 |
| Find all providers in zip 39360 | ||||
| Taxonomy Code | 343900000X |
| Grouping | Transportation Services |
| Classification | Non-emergency Medical Transport (VAN) |
| A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053882415 | Debra Eloise Bender | Non-emergency Medical Transport (VAN) | 6320 County Road 610, Shubuta, MS 39360 | 2018-12-11 |
| 1447723358 | Elite Transportation-ms, LLC | Non-emergency Medical Transport (VAN) | 6320 County Road 610, Shubuta, MS 39360-9329 | 2019-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972116713 | Harold Cooper | Non-emergency Medical Transport (VAN) | 790 County Road 101, Abbeville, MS 38601-9663 | 2020-08-30 |
| 1093327884 | T & T Nemt Services, LLP | Non-emergency Medical Transport (VAN) | 2927 Highway 532, Taylorsville, MS 39168-4633 | 2020-08-21 |
| 1891304234 | Catrina D Kitchens | Non-emergency Medical Transport (VAN) | 212 N Bierdeman Rd, Pearl, MS 39208-4611 | 2020-07-30 |
| 1073131835 | Moral Lyft | Non-emergency Medical Transport (VAN) | 615a Govan Ave, Holly Springs, MS 38635-2110 | 2020-07-08 |
| 1518581511 | Tracey Bryant | Non-emergency Medical Transport (VAN) | 1160 Rosewood St, Jackson, MS 39212-3966 | 2020-06-04 |
| 1194346676 | Watson Transportation Com LLC | Non-emergency Medical Transport (VAN) | 630 Norris St, Greenville, MS 38703-6042 | 2020-05-06 |
| 1851910830 | Stepping Out Transportation Service LLC | Non-emergency Medical Transport (VAN) | 523 Brentwood Ave, Greenwood, MS 38930-6910 | 2020-04-10 |
| 1275169773 | Bruce Edward Hunt | Non-emergency Medical Transport (VAN) | 116 Pine Dr, Hattiesburg, MS 39401-8408 | 2020-03-16 |
| 1831723154 | Love Thy Neighbor Non Emergency Transportation Service | Non-emergency Medical Transport (VAN) | 5970 Ferncreek Dr, Jackson, MS 39211-2723 | 2020-02-25 |
| 1467091371 | Jerry Dixon Jr. | Non-emergency Medical Transport (VAN) | 14337 Highway 12 W, Kosciusko, MS 39090-3689 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
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| 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.