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JACKSON PHYSICIAN CORP NPI 1134261167


NPI Information

NPI: 1134261167
Provider Name: JACKSON PHYSICIAN CORP

Doing Business As: BOONEVILLE MEDICAL CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
HWY 11 SOUTH
BOONEVILLE, KY
ZIP 41314
Phone: (606) 693-0531
Get Directions

JACKSON PHYSICIAN CORP is a family medicine in Booneville, KY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. JACKSON PHYSICIAN CORP NPI is 1134261167. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Booneville Medical Clinic.

The provider's business location address is:

HWY 11 SOUTH
BOONEVILLE, KY
ZIP 41314-621
Phone: (606) 693-0531
Fax: (606) 693-0535

The provider's authorized official is Loretta L Campbell .
The authorized official title is Clinic Coordinator and has the following contact phone number (606) 593-5395.

The enumeration date for this NPI number is 2/13/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine02940KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
165926594MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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