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Organization
ARCHER CLINIC ASSOCIATES
Active
Organization
ARCHER CLINIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JEROME HIERONYMUS JR. M.D. (PARTNER)
(606) 886-3887
Entity
Organization
Contact information
Practice address
400 UNIVERSITY DR, SUITE 103, PRESTONBURG, KY 41653
(606) 886-3887
(606) 886-3818
Mailing address
400 UNIVERSITY DRIVE, SUITE 103, PRESTONBURG, KY 41653
(606) 886-3888
(606) 886-3818
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000046040
BLUE CROSS BLUE SHIELD
—
01
—
1002252
UNITED MINE WORKERS OF AM
—
01
—
103141
BLACK LUNG
—
01
—
16846
KY LICENSE NUMBER
—
Enumeration date
07/27/2007
Last updated
03/07/2023
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