NPIMap

Organization Active NPI

Mitchell Wicker Jr MD PSC

Doing business as Hazard Clinic

  • Internal Medicine Physician
  • Hazard, KY
National Provider Identifier
1093718116
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21790 Issued in KY
Legal business name
MITCHELL WICKER JR MD PSC
Doing business as
Hazard Clinic
Practice address
271 E Main St
Hazard, KY 41701-1939
Phone
(606) 439-1316
Fax
(606) 435-0752
NPI assigned
May 23, 2005
Last updated
Jan 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

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

Authorized official

Name
Mitchell Wicker Jr., MDNPI 1730182841
Title
Owner
Phone
(606) 439-1316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21790 KY Primary

Addresses

Primary practice location

271 E Main St
Hazard, KY 41701-1939

Mailing address

PO Box 719
Hazard, KY 41702-0719
Phone (606) 439-1316

Other identifiers 1

IdentifierTypeStateIssuer
31001035MedicaidKY

Other names 1

  • Hazard Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

271 E Main St
Hazard, KY 41701
Phone (606) 439-1316

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1093718116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417020719",
            "telephone_number": "606-439-1316",
            "fax_number": "606-435-0752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 E MAIN ST",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417011939",
            "telephone_number": "606-439-1316",
            "fax_number": "606-435-0752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL WICKER JR MD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "WICKER",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-439-1316",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "21790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31001035",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazard Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazard, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; 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.