Organization
JACKSON PHYSICIAN CORP
Active
Other names
DBA JACKSON UROLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA L CAMPBELL (CLINIC COORDINATOR)
(606) 693-0531
Entity
Organization
Contact information
Practice address
1550 HIGHWAY 15 S STE 27, JACKSON, KY 41339-8604
(606) 693-0116
(606) 693-0118
Mailing address
PO BOX 790, JACKSON, KY 41339-0790
(606) 693-0531
(606) 693-0535
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
25492
KY
Other
Enumeration date
05/31/2007
Last updated
08/22/2020
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