Organization
JACKSON PHYSICIAN CORP
Active
Other names
BOONEVILLE MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA L CAMPBELL (CLINIC COORDINATOR)
(606) 593-5395
Entity
Organization
Contact information
Practice address
HWY 11 SOUTH, BOONEVILLE, KY 41314-9621
(606) 693-0531
(606) 693-0535
Mailing address
HWY 11 SOUTH, BOONEVILLE, KY 41317
(606) 593-5395
(606) 593-5444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02940
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65926594
—
KY
Enumeration date
02/13/2007
Last updated
08/22/2020
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