1073643599 NPI number — JESSAMINE CHRISTIAN HEALTHCARE, INC.

Table of content: (NPI 1073643599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073643599 NPI number — JESSAMINE CHRISTIAN HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSAMINE CHRISTIAN HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JESSAMINE CHRISTIAN HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073643599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 RICE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMORE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40390-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-858-9355
Provider Business Mailing Address Fax Number:
859-858-0416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 RICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40390-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-858-9355
Provider Business Practice Location Address Fax Number:
859-858-0416
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
BUSINESS DIRECTOR
Authorized Official Telephone Number:
859-858-9355

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  31991 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 34906 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3843156 . This is a "DR. COBURN'S CIGNA #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5842674 . This is a "DR. COBURN AETNA PPO #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64319916 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64029648 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72935 . This is a "DR. COBURN AETNA HMO #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 10305 . This is a "DR. COBURN CHA #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000052187 . This is a "DR. COBURN ANTHEM #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2614700 . This is a "DR. HUFFMAN'S AETNA PPO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65932030 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72935 . This is a "DR. HUFFMAN'S AETNA HMO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000052187 . This is a "DR. COBURN BCBS #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000191189 . This is a "DR. HUFFMAN ANTHEM #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000191189 . This is a "DR. HUFFMAN'S BCBS #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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