Healthcare Provider Details

I. General information

NPI: 1942064134
Provider Name (Legal Business Name): JACKSON COUNTY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 03/06/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. WATER STREET
MCKEE KY
40447
US

IV. Provider business mailing address

725 S MAIN ST
LONDON KY
40741-1903
US

V. Phone/Fax

Practice location:
  • Phone: 606-770-5161
  • Fax:
Mailing address:
  • Phone: 606-770-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATASHA SIGMON
Title or Position: OPERATIONS
Credential:
Phone: 859-457-5050