Provider Demographics
NPI:1346385630
Name:JENKINS HEALTHCARE COMPANY BDA JENKINS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:JENKINS HEALTHCARE COMPANY BDA JENKINS COMMUNITY HOSPITAL
Other - Org Name:JENKINS FAMILY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-832-2171
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-0472
Mailing Address - Country:US
Mailing Address - Phone:606-832-2171
Mailing Address - Fax:606-832-2943
Practice Address - Street 1:9480 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537
Practice Address - Country:US
Practice Address - Phone:606-832-2171
Practice Address - Fax:606-832-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000888Medicaid
KY3979Medicare ID - Type UnspecifiedPRIMACY CARE CLINIC