Provider Demographics
NPI:1053347260
Name:JACKSON'S ADVANTAGE HOLDINGS INC.
Entity type:Organization
Organization Name:JACKSON'S ADVANTAGE HOLDINGS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-836-5257
Mailing Address - Street 1:2305 BECKER DR
Mailing Address - Street 2:STE. B
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5758
Mailing Address - Country:US
Mailing Address - Phone:979-836-5257
Mailing Address - Fax:979-836-5258
Practice Address - Street 1:2305 BECKER DR
Practice Address - Street 2:STE. B
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5758
Practice Address - Country:US
Practice Address - Phone:979-836-5257
Practice Address - Fax:979-836-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083430332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5574750001Medicare NSC