St. John Neumann'S Extended Hours Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

KY24420 Issued in KY

Legal business name

ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC

Practice address

1389 Highway 15 North
Jackson, KY 41339

Phone

(606) 666-4011

Fax

(606) 666-5801

NPI assigned

Oct 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Theresa Merced

Title

Office Manager

Phone

(606) 666-4011

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1003004912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390606",
            "telephone_number": "606-666-4011",
            "fax_number": "606-666-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 HIGHWAY 15 NORTH",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "41339",
            "telephone_number": "606-666-4011",
            "fax_number": "606-666-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "MERCED",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "606-666-4011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "KY24420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Jackson, KY
• Providers in Jackson, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.