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General NPI Number Information
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NPI Number | 1770773525
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Entity Type | Organization
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Legal Business Name | ARCHER CLINIC ASSOCIATES
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 400 UNIVERSITY DR SUITE 103
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City | PRESTONBURG
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State | KY
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Zip | 41653
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Country | US
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Telephone | 606-886-3887
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Fax | 606-886-3818
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Provider Business Mailing Address
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Address Line | 400 UNIVERSITY DRIVE SUITE 103
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City | PRESTONBURG
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State | KY
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Zip | 41653
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Country | US
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Telephone | 606-886-3888
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Fax | 606-886-3818
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Authorized Official
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Title or Position | PARTNER
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Name | CHARLES JEROME HIERONYMUS JR.
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Credential | M.D.
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Telephone | 606-886-3887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | KY
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