Provider Demographics
NPI:1477569226
Name:AARON K. JONAN MEMORIAL CLINIC INC.
Entity Type:Organization
Organization Name:AARON K. JONAN MEMORIAL CLINIC INC.
Other - Org Name:AARON JONAN MEMORIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DJIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-794-5600
Mailing Address - Street 1:832 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-8284
Mailing Address - Country:US
Mailing Address - Phone:606-666-5142
Mailing Address - Fax:606-666-4172
Practice Address - Street 1:832 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8284
Practice Address - Country:US
Practice Address - Phone:606-666-5142
Practice Address - Fax:606-666-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43629208000000X
KY900029261QR1300X, 261QR1300X
KY3006826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100336880Medicaid
KY183821Medicare Oscar/Certification
KY7100336880Medicaid