Provider Demographics
NPI:1942064134
Name:JACKSON COUNTY CLINIC, LLC
Entity Type:Organization
Organization Name:JACKSON COUNTY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-457-5050
Mailing Address - Street 1:725 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1903
Mailing Address - Country:US
Mailing Address - Phone:606-770-5161
Mailing Address - Fax:
Practice Address - Street 1:200 W. WATER STREET
Practice Address - Street 2:
Practice Address - City:MCKEE
Practice Address - State:KY
Practice Address - Zip Code:40447
Practice Address - Country:US
Practice Address - Phone:606-770-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health