Provider Demographics
NPI:1073643599
Name:JESSAMINE CHRISTIAN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JESSAMINE CHRISTIAN HEALTHCARE, INC.
Other - Org Name:JESSAMINE CHRISTIAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-858-9355
Mailing Address - Street 1:200 RICE ST
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1359
Mailing Address - Country:US
Mailing Address - Phone:859-858-9355
Mailing Address - Fax:859-858-0416
Practice Address - Street 1:200 RICE ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1359
Practice Address - Country:US
Practice Address - Phone:859-858-9355
Practice Address - Fax:859-858-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31991207Q00000X
KY34906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3843156OtherDR. COBURN'S CIGNA #
KY5842674OtherDR. COBURN AETNA PPO #
KY64319916Medicaid
KY64029648Medicaid
KY72935OtherDR. COBURN AETNA HMO #
KY10305OtherDR. COBURN CHA #
KY000000052187OtherDR. COBURN ANTHEM #
KY2614700OtherDR. HUFFMAN'S AETNA PPO
KY65932030Medicaid
KY72935OtherDR. HUFFMAN'S AETNA HMO
KY000000052187OtherDR. COBURN BCBS #
KY000000191189OtherDR. HUFFMAN ANTHEM #
KY000000191189OtherDR. HUFFMAN'S BCBS #
KY72935OtherDR. COBURN AETNA HMO #
KY2614700OtherDR. HUFFMAN'S AETNA PPO
KY000000191189OtherDR. HUFFMAN ANTHEM #
KY3843156OtherDR. COBURN'S CIGNA #
KY72935OtherDR. HUFFMAN'S AETNA HMO