NPIMap

Organization Active NPI

Jackson Physician Corp

  • Pediatric Urology Physician
  • Jackson, KY
National Provider Identifier
1023219425
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
25492 Issued in KY
Legal business name
JACKSON PHYSICIAN CORP
Practice address
1550 Highway 15 S Ste 27
Jackson, KY 41339-8604
Phone
(606) 693-0116
Fax
(606) 693-0118
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Loretta L Campbell
Title
Clinic Coordinator
Phone
(606) 693-0531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2088P0231X 25492 KY Primary

Addresses

Primary practice location

1550 Highway 15 S Ste 27
Jackson, KY 41339-8604

Mailing address

PO Box 790
Jackson, KY 41339-0790
Phone (606) 693-0531

Other names 1

  • DBA JACKSON UROLOGY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Booneville Medical Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1885/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023219425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390790",
            "telephone_number": "606-693-0531",
            "fax_number": "606-693-0535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 HIGHWAY 15 S STE 27",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413398604",
            "telephone_number": "606-693-0116",
            "fax_number": "606-693-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PHYSICIAN CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "606-693-0531"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": "KY",
            "license": "25492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA JACKSON UROLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.