Michaelis B Jackson (NPI# 1700951993, PAC ID# 7416040407) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPHTHALMOLOGY.
| Nation Provider ID (NPI) | 1700951993 |
| PAC ID by PECOS | 7416040407 |
| Professional Enrollment ID | I20070913000241 |
| Full Name | Michaelis B Jackson |
| Organization Legal Name | MICHAELIS JACKSON AND ASSOCIATES, LLC |
| Address |
2800 W Main St Carbondale IL 62901-1087 |
| Phone Number | 6123518900 |
| Gender | M |
| Medical School | MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE |
| Graduation Year | 1985 |
| Primary Specialty | OPHTHALMOLOGY |
| Group Practice PAC ID | 9032202031 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140011 | HERRIN HOSPITAL |
| 140164 | MEMORIAL HOSPITAL OF CARBONDALE |
| 141334 | ST JOSEPH MEMORIAL HOSPITAL |
| 140210 | HARRISBURG MEDICAL CENTER |
| 140184 | HEARTLAND REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2800 W Main St, Carbondale, IL 62901-1087 | 6123518900 | MICHAELIS JACKSON AND ASSOCIATES, LLC |
| 2800 W Main St, Jackson Vision and Laser Center, Carbondale, IL 62901-1087 | 6123518900 | MICHAELIS JACKSON AND ASSOCIATES, LLC |
| Organization Legal Name | MICHAELIS JACKSON AND ASSOCIATES, LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kelly A Davis | Optometry | Michaelis Jackson and Associates, LLC | 2800 W Main St, Jackson Vision and Laser Center, Carbondale, IL 62901-1087 |
| Street Address |
2800 W MAIN ST |
| City | CARBONDALE |
| State | IL |
| Zip | 62901-1087 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jim Lieblong | Optometry | 2800 W Main St, Russellville, AR 72801-2449 | |
| Kelly A Davis | Optometry | Michaelis Jackson and Associates, LLC | 2800 W Main St, Jackson Vision and Laser Center, Carbondale, IL 62901-1087 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy Nichole Dinga | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Carlos Mario Rivera Serrano | Plastic and Reconstructive Surgery | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Kelli Nicole Webb | Plastic and Reconstructive Surgery | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
| Fakhre Alam | Neurology | 2731 W Main St, Suite A, Carbondale, IL 62901-1028 | |
| Muhammad J Popalzai | Hematology/oncology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Melissa Andrea Martinez Mateo | Gastroenterology | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Lukas John Ward | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Emily D Hanson | Family Medicine | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Phillip A Dewey | Physician Assistant | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Jessie Nicole Fox | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 2601 W Main St, Carbondale, IL 62901-1031 |
| Find all physicians in zip 62901 | |||
| City | CARBONDALE |
| Zip Code | 62901 |
| Specialty | OPHTHALMOLOGY |
| City + Specialty | CARBONDALE + OPHTHALMOLOGY |
Please comment or provide details below to improve the information on Michaelis B Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.