Provider Demographics
NPI:1609378132
Name:COUNTY LINE PRIMARY CARE
Entity Type:Organization
Organization Name:COUNTY LINE PRIMARY CARE
Other - Org Name:JACKSON MEDICAL CLINIC FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-824-5037
Mailing Address - Street 1:41 JOHN MACO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-6515
Mailing Address - Country:US
Mailing Address - Phone:606-568-1184
Mailing Address - Fax:
Practice Address - Street 1:1550 HIGHWAY 15 S STE 240
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-0709
Practice Address - Country:US
Practice Address - Phone:606-568-1184
Practice Address - Fax:606-824-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health