NPIMap

Organization Active NPI

Jackson Womens Care

  • Gynecology Physician
  • Jackson, KY
National Provider Identifier
1114134814
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
21623 Issued in KY
Legal business name
JACKSON WOMENS CARE
Practice address
540 Jett Dr
Jackson, KY 41339-9622
Phone
(606) 666-6240
NPI assigned
May 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Gynecology Physician 207VG0400X 21623 KY Primary

Addresses

Primary practice location

540 Jett Dr
Jackson, KY 41339-9622

Mailing address

PO Box 790
Jackson, KY 41339-0790
Phone (606) 666-6240

Other identifiers 1

IdentifierTypeStateIssuer
65926974MedicaidKY

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.

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114134814",
    "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": "606-666-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 JETT DR",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399622",
            "telephone_number": "606-666-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON WOMENS CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "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": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "KY",
            "license": "21623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65926974",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.