Provider Demographics
NPI:1104004845
Name:DAVID J JENKINSON MD
Entity Type:Organization
Organization Name:DAVID J JENKINSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:B LEMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-325-1765
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105
Mailing Address - Country:US
Mailing Address - Phone:606-325-1765
Mailing Address - Fax:606-324-1267
Practice Address - Street 1:2501 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-325-1765
Practice Address - Fax:606-324-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
KY32201207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64322019Medicaid
KY5449150001Medicare NSC
KYG43775Medicare UPIN
KY9035Medicare PIN