Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Thomas V Jackson, MD

Individual provider Emergency Medicine Physician · NPI 1700862992

Thomas V Jackson, MD is an Emergency Medicine Physician in Portage, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2005.

Licensed in
WI
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2817 New Pinery Rd Divine Savior Healthcare Inc
Portage, WI 53901-9257
Phone: (608) 742-4131
Fax: (608) 745-5173
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 21269020 (WI)

Record details

NPI number1700862992
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedDecember 20, 2005
Last updated in NPPESJanuary 30, 2012
Mailing addressPo Box 387, Divine Savior Healthcare Inc, Portage, WI 53901-0387

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