| Clemente V. Zulueta, Jr., Md, Pllc | |
|
95 Jackson Hts Ste 201 Jackson KY 41339-6500 | |
| (606) 693-1078 | |
| (606) 693-1079 |
| Full Name | Clemente V. Zulueta, Jr., Md, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 95 Jackson Hts, Jackson, Kentucky |
| Authorized Official Name and Position | Clemente V. Zulueta (OWNER) |
| Authorized Official Contact | 6066931078 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clemente V. Zulueta, Jr., Md, Pllc Po Box 908 Jackson KY 41339-0908 Ph: (606) 693-1078 | Clemente V. Zulueta, Jr., Md, Pllc 95 Jackson Hts Ste 201 Jackson KY 41339-6500 Ph: (606) 693-1078 |
| NPI Number | 1275543175 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 07/02/2012 |
| Medicare PECOS PAC ID | 2264419811 |
|---|---|
| Medicare Enrollment ID | O20040701001257 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275543175 | NPI | - | NPPES |
| 31-000847 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Clemente V Zulueta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831109743 PECOS PAC ID: 7719872308 Enrollment ID: I20040223000054 |
| Provider Name | Elizabeth Potter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154478162 PECOS PAC ID: 7113997339 Enrollment ID: I20040727000542 |
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