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General NPI Number Information
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NPI Number | 1598040628
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Entity Type | Organization
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Legal Business Name | JACKSON URGENT CARE
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 731 E MAIN ST
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City | JACKSON
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State | OH
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Zip | 45640-2100
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Country | US
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Telephone | 740-418-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 731 E MAIN ST
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City | JACKSON
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State | OH
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Zip | 45640-2100
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Country | US
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Telephone | 740-418-1200
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NATALIE R. KING
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Credential | D.O
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Telephone | 740-418-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 2264
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License Number State | WV
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