NPIMap

Organization Active NPI

Purchase Derm-ENT, PLLC

  • Otolaryngology Physician
  • Paducah, KY
National Provider Identifier
1336101179
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
PURCHASE DERM-ENT, PLLC
Practice address
2605 Kentucky Avenue
Dob 3, Suite 601
Paducah, KY 42003-3800
Phone
(270) 408-4368
Fax
(570) 408-3272
NPI assigned
Apr 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

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

Authorized official

Name
Shawn C Jones, M.D.
Title
Partner
Phone
(570) 408-4368

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2605 Kentucky Avenue
Dob 3, Suite 601
Paducah, KY 42003-3800

Mailing address

2605 Kentucky Avenue
Dob 3, Suite 601
Paducah, KY 42003-3800
Phone (270) 408-4368

Other identifiers 2

IdentifierTypeStateIssuer
7100198720MedicaidKY
78903721MedicaidKY

National Provider Directory

National Provider Directory

Locations

300 S 8th St
Ste 201E
Murray, KY 42071
Phone (270) 762-1571

4645 Village Square Dr
#105
Paducah, KY 42001
Phone (270) 705-0840

Practitioners & affiliated clinicians

Practitioners 12

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": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1336101179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 KENTUCKY AVENUE",
            "address_2": "DOB 3, SUITE 601",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420033800",
            "telephone_number": "270-408-4368",
            "fax_number": "570-408-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 KENTUCKY AVENUE",
            "address_2": "DOB 3, SUITE 601",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420033800",
            "telephone_number": "270-408-4368",
            "fax_number": "570-408-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURCHASE DERM-ENT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "570-408-4368",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100198720",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78903721",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.