Individual ProviderRichard JacksonStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address3601 4th St, Ms 8103, Lubbock, TX 79430-0002(806) 743-2800PECOS EnrollmentBased on the most recent information from CMS, provider Richard Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1043480007Provider TypeIndividualFull NameJackson, RichardCredentialMD0416GenderMaleSole ProprietorNoEnumeration Date3/6/2008Last Updated3/6/2008Contact InformationPractice LocationPractice Address3601 4th St, Ms 8103, Lubbock, TX 79430-0002Phone(806) 743-2800FaxUnlisted FaxMailing LocationMailing Address3601 4th St, Ms 8103, Lubbock, TX 79430-0002Phone(806) 743-2800FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerTexas