| Jackson Physician Corp | |
|
Hwy 11 South Booneville KY 41314-9621 | |
| (606) 693-0531 | |
| (606) 693-0535 |
| Full Name | Jackson Physician Corp |
|---|---|
| Speciality | Family Medicine |
| Location | Hwy 11 South, Booneville, Kentucky |
| Authorized Official Name and Position | Loretta L Campbell (CLINIC COORDINATOR) |
| Authorized Official Contact | 6065935395 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Physician Corp Hwy 11 South Booneville KY 41317 Ph: (606) 593-5395 | Jackson Physician Corp Hwy 11 South Booneville KY 41314-9621 Ph: (606) 693-0531 |
| NPI Number | 1134261167 |
|---|---|
| Provider Enumeration Date | 02/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134261167 | NPI | - | NPPES |
| 65926594 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 02940 (Kentucky) | Primary |
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