ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC NPI 1003004912

Family Medicine in Jackson, KY

About ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC

St. John Neumann's Extended Hours Clinic is a provider in Jackson, KY. The NPI number assigned to this provider is 1003004912. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an organization and their NPI record was last updated 10 years ago. St. John Neumann's Extended Hours Clinic operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI1003004912 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameST. JOHN NEUMANN'S EXTENDED HOURS CLINIC
Provider Location Address1389 HIGHWAY 15 NORTH JACKSON, KY 41339 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing AddressPO BOX 606 JACKSON, KY 41339 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-05-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date10-05-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC
1389 HIGHWAY 15 NORTH
JACKSON, KY
ZIP 41339
Phone: (606) 666-4011
Fax: (606) 666-5801
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Mailing Address

ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC
PO BOX 606
JACKSON, KY
ZIP 41339
Phone: (606) 666-4011
Fax: (606) 666-5801

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.KY24420
License StateKY
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Authorized Official

Authorized Official NameMRS. THERESA MERCED Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleOFFICE MANAGER
Authorized Official Phone(606) 666-4011

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Map Location


ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC address is 1389 HIGHWAY 15 NORTH JACKSON, KY 41339