Provider Demographics
NPI:1023164779
Name:JAYMARK MEDICAL
Entity type:Organization
Organization Name:JAYMARK MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-563-9501
Mailing Address - Street 1:369 ADAMS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-6505
Mailing Address - Country:US
Mailing Address - Phone:615-563-9501
Mailing Address - Fax:615-563-9502
Practice Address - Street 1:369 ADAMS RIDGE LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-6505
Practice Address - Country:US
Practice Address - Phone:615-563-9501
Practice Address - Fax:615-563-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0301400001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0301400001OtherMEDICARE NCS ID NUMBER
TN1450018Medicaid
TN0143558OtherBLUE CROSS BLUE SHEILD