Provider Demographics
NPI:1265658314
Name:JAMCO OF KY. INC.
Entity Type:Organization
Organization Name:JAMCO OF KY. INC.
Other - Org Name:JACKSON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-666-9293
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0803
Mailing Address - Country:US
Mailing Address - Phone:606-666-9293
Mailing Address - Fax:606-666-9220
Practice Address - Street 1:695 KY. HWY. 15 NORTH
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-666-9293
Practice Address - Fax:606-666-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2538225100000X
KY4578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1235291584OtherNPI
KY1619039989OtherNPI
KY=========OtherTAX ID
KY5026601Medicare ID - Type Unspecified