Look up the most recent NPI and PECOS records

Keith A Jackson Md Limited

Specialist

Other Service Providers

8010 Frost St, 503, San Diego, CA 92123-2778

PECOS Enrollment

Based on the most recent information from CMS, provider Keith A Jackson Md Limited does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1487823324
Provider Type
Organization
Full Name
Keith A Jackson Md Limited

Subpart
No
Enumeration Date
2/25/2008
Last Updated
2/25/2008

Contact Information

Practice Location

8010 Frost St, 503, San Diego, CA 92123-2778

(858) 279-4221

(858) 279-4223

Mailing Location

8010 Frost St, 503, San Diego, CA 92123-2778

(858) 279-4221

(858) 279-4223

Authorized Official

Baker, Lisa Marie (Office Manager)

(858) 279-4221

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License G58187 California

Keith A Jackson Md Limited

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

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