DR. MITCHELL WELLS JACOCKS


Address: 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815
Phone: 8037444940

DR. MITCHELL WELLS JACOCKS (NPI# 1881667897) 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) 1881667897
Entity Type Individual
Full Name DR. MITCHELL WELLS JACOCKS
Credential MD
Practice Address 2728 Sunset Blvd Ste 300
West Columbia
SC 29169-4815
Mailing Address Po Box 6069
West Columbia
SC 29171-6069
Practice Telephone 8037444940
Practice Fax Number 8037444938
Enumeration Date 2006-02-09
Last Update Date 2020-11-06
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
20836 SC Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
SC RRMEDICARE CC5386 01
SC T49604 05

Office Location

Street Address 2728 SUNSET BLVD STE 300
City WEST COLUMBIA
State SC
Zip Code 29169-4815

Providers in the same location

NPI Name Taxonomy Address Enumeration
1083211312 Lexington Health Inc Internal Medicine 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2020-10-09
1770116477 Jamie L Odom Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2020-02-20
1033742531 Keelin Jamaal Golden-maldonado Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2020-02-13
1912544198 Casey Hendrix Purcell Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-12-05
1588200661 Kaitlyn A Keenan Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-11-22
1770128613 Lisa Mondo Davis Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-11-14
1265077622 Rachel S Fogarty Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-11-08
1275093155 Nyesha Nicole Hall Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-03-25
1700345303 Kristina Allane Bristow Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2019-03-14
1609347129 Jessica Jems Oing Nurse Practitioner 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2018-12-10
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1457960726 Jerry Scott Oreilly Physical Therapy Assistant 100 Dreher Rd, Suite 100, West Columbia, SC 29169 2020-07-23
1134759921 A&m Medical, LLC Durable Medical Equipment & Medical Supplies 1053 Sunset Boulevard, West Columbia, SC 29169 2020-01-21
1750946067 First Physical Therapy, LLC Clinic/Center 100 Dreher Rd., Suite 100, West Columbia, SC 29169 2019-05-02
1295217545 Tynaka Kwans Wilson Nurse Practitioner Sc House Calls Inc, 1053 Center Street, West Columbia, SC 29169 2018-09-04
1588183826 Kimberly Jane Jennings Registered Nurse 1052 Center Street, Sc House Calls Inc, West Columbia, SC 29169 2017-09-19
1164943213 Jacob Luke Wayland Emergency Medicine Lexington Medical Center-emergency Medicine Dept, 2720 Sunset Blvd, West Columbia, SC 29169 2017-06-29
1740721232 Heather Detwiler Physical Therapy Assistant 2705 Leaphart Rd., Carolina Gardens, West Columbia, SC 29169 2017-03-16
1588110761 Virginia I Hall Nurse Practitioner 2720 Susnet Blvd, West Columbia, SC 29169 2016-08-29
1215395744 Stacey Khalifa Social Worker 160 Medical Cir Fl 1, West Columbia, SC 29169 2016-01-28
1407252331 Sandy Frye Boone Counselor 2318 Sunset Blvd # 2a, West Columbia, SC 29169 2014-11-04
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Taxonomy Information

Taxonomy Code 207RC0000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Cardiovascular Disease

Taxonomy Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1083995641 Providence Cardiology LLC Internal Medicine 3103 Sunset Blvd, West Columbia, SC 29169-4817 2011-09-08
1124222807 Columbia Cardiology, LLC Internal Medicine 131 Sunset Court, West Columbia, SC 29169-3405 2007-06-14
1831166602 Lexington Heart Clinic, LLC Internal Medicine 120 Hospital Dr. W, West Columbia, SC 29169-3406 2006-03-01
1427057009 Daniel P Bouknight Internal Medicine 3020 Sunset Blvd Ste 105, West Columbia, SC 29169-3494 2005-07-18
1417119017 South Carolina Heart Center Pa Internal Medicine 2728 Sunset Blvd, Ste 401, West Columbia, SC 29169-4840 2008-06-26
1063696011 Jonathan Kyle Hewett Internal Medicine 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2007-12-27
1639208671 William D. Brearley Jr. Internal Medicine 2728 Sunset Blvd Ste 300, West Columbia, SC 29169 2007-03-05
1275622979 Stephen Earl Van Horn, Jr Jr. Internal Medicine 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2006-10-12
1235247198 Amy R. Epps Internal Medicine 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 2006-08-29
1427084102 Ram G Penmetsa Internal Medicine 2728 Sunset Blvd, Suite 401, West Columbia, SC 29169-4840 2006-06-24
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Competitor

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City WEST COLUMBIA
Zip Code 29169

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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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