Provider Demographics
NPI:1972881324
Name:J. R. HOLDINGS, INC
Entity Type:Organization
Organization Name:J. R. HOLDINGS, INC
Other - Org Name:ST. CAMILLUS URGENT CARE OF HENDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-844-8232
Mailing Address - Street 1:612 BARRETT BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2620
Mailing Address - Country:US
Mailing Address - Phone:270-844-8232
Mailing Address - Fax:270-844-8238
Practice Address - Street 1:612 BARRETT BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2620
Practice Address - Country:US
Practice Address - Phone:270-844-8232
Practice Address - Fax:270-844-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100179140Medicaid
KYK029800Medicare PIN