# ST. JOHN NEUMANN'S EXTENDED HOURS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003004912
- **Authorized official:** MRS. THERESA MERCED (OFFICE MANAGER)
- **Authorized official phone:** (606) 666-4011

## Contact information

- **Practice address:** 1389 HIGHWAY 15 NORTH, JACKSON, KY 41339
- **Practice address phone:** (606) 666-4011
- **Practice address fax:** (606) 666-5801
- **Mailing address:** PO BOX 606, JACKSON, KY 41339-0606
- **Mailing address phone:** (606) 666-4011
- **Mailing address fax:** (606) 666-5801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | KY24420 | KY | Yes |

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 10/05/2007