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Contact Information

JACKSON ENT CLINIC , PSC
1550 HIGHWAY 15 S STE 29
JACKSON, KY41339-9221
 Phone: 606-666-9909
 Fax: 606-666-9982
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Oral & Maxillofacial Surgery

204E00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for JACKSON ENT CLINIC PSC · (Female)

NPI Number 1831225465
Status Active
Credentials
Entity Individual
Enumeration date 02/26/2007
Last updated 11/14/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • KY License # 36227
  • KY Medicaid SA64023724
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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