Provider Demographics
NPI:1366739526
Name:FIRST ON SITE
Entity type:Organization
Organization Name:FIRST ON SITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISANT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA JENKINS
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-931-8999
Mailing Address - Street 1:275 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2321
Mailing Address - Country:US
Mailing Address - Phone:502-564-5555
Mailing Address - Fax:502-696-3996
Practice Address - Street 1:275 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2321
Practice Address - Country:US
Practice Address - Phone:502-564-5555
Practice Address - Fax:502-696-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006462261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health