1629542469 NPI number — LEWIS COUNTY PRIMARY CARE CENTER, INC.

Table of content: JAJIN THOMAS CHON M.D. (NPI 1346320553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629542469 NPI number — LEWIS COUNTY PRIMARY CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY PRIMARY CARE CENTER, 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:
Provider Other Organization Name Type Code:
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:
1629542469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 KY 59
Provider Second Line Business Mailing Address:
PO BOX 550
Provider Business Mailing Address City Name:
VANCEBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-956-0188
Provider Business Mailing Address Fax Number:
606-796-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
432 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-956-0188
Provider Business Practice Location Address Fax Number:
606-796-6010
Provider Enumeration Date:
01/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
ERWIN
Authorized Official Title or Position:
DIRECTOR OF PHARMACY AND ANCILLARY
Authorized Official Telephone Number:
606-956-0188

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P08020 . This is a "KY BOARD OF PHARMACY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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