Provider Demographics
NPI:1013106186
Name:MERCER MEDICAL ASSOCIATES PSC
Entity Type:Organization
Organization Name:MERCER MEDICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:COZATT
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:859-734-4307
Mailing Address - Street 1:470 LINDEN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1871
Mailing Address - Country:US
Mailing Address - Phone:859-734-4307
Mailing Address - Fax:859-734-4300
Practice Address - Street 1:470 LINDEN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1871
Practice Address - Country:US
Practice Address - Phone:859-734-4307
Practice Address - Fax:859-734-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6066Medicare PIN