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MERCY CLINIC OF JACKSON PLLC NPI 1306047105


NPI Information

NPI: 1306047105
Provider Name: MERCY CLINIC OF JACKSON, PLLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 18D1045802

Address:
1550 HIGHWAY 15 S
SUITE 80
JACKSON, KY
ZIP 41339
Phone: (606) 693-0343
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MERCY CLINIC OF JACKSON, PLLC is a specialist in Jackson, KY. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MERCY CLINIC OF JACKSON, PLLC NPI is 1306047105. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1550 HIGHWAY 15 S
SUITE 80
JACKSON, KY
ZIP 41339-247
Phone: (606) 693-0343
Fax: (606) 693-0322

The provider's authorized official is Susan Pratt .
The authorized official title is Clinic Manager and has the following contact phone number (606) 693-0343.

The CLIA number assigned to this NPI record is 18D1045802 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/30/2007 and was last updated on 10/4/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist31497KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
19700MEDICARE ID-TYPE UNSPECIFIEDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.