VAUGHN D JACKSON, PLLC
NPI 1710308952
Clinic/Center - Medical Specialty in La Jara, CO
- Organization
- Clinic/Center
- Medical Specialty
- CLIA Number: 06D2079919
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-25-2026
About VAUGHN D JACKSON, PLLC
This page provides the complete NPI Profile along with additional information for Vaughn D Jackson, Pllc, a provider established in La Jara, Colorado operating as a Clinic/center, focusing in medical specialty . The healthcare provider is registered in the NPI registry with number 1710308952 assigned on December 2013. The practitioner's primary taxonomy code is 261QM2500X with license number 31351 (CO). The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Dr. Vaughn D Jackson M.d. (Sole Member)
- NPI
- 1710308952 Verify this NPI
- Provider Name
- VAUGHN D JACKSON, PLLC
- Entity Type
- Organization
- Location Address
- 412 MAIN LA JARA, CO 81140
- Location Phone
- (719) 274-4500
- Location Fax
- (719) 274-4504
- Mailing Address
- P.O. BOX 272 416 MAIN LA JARA, CO 81140
- Mailing Phone
- (719) 274-4500
- Mailing Fax
- (719) 274-4504
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-13-2013
- Last Update Date
- 12-13-2013
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Medical Specialty
- Taxonomy Code
- 261QM2500X
- Type
- Ambulatory Health Care Facilities
- License No.
- 31351
- License State
- CO
- Taxonomy Description
- An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 06D2079919
- Facility Type
- Physician Office
- Certificate Effective Date
- June 26, 2024
- Certificate Expiration Date
- June 25, 2026
- Laboratory Director
- DR. VAUGHN D. JACKSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Vaughn D Jackson, Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1710308952, enumerated as an "organization" on December 13, 2013.
The provider is located at 412 MAIN LA JARA, CO 81140 and the phone number is (719) 274-4500.
Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.
