| Jcr Do Plc | |
|
11275 Sprague Rd Delton MI 49046-8493 | |
| (269) 623-7121 | |
| (269) 623-5527 |
| Full Name | Jcr Do Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 11275 Sprague Rd, Delton, Michigan |
| Authorized Official Name and Position | Joseph C. Roth (OWNER) |
| Authorized Official Contact | 2696237121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jcr Do Plc 11275 Sprague Rd Delton MI 49046-8493 Ph: (269) 623-7121 | Jcr Do Plc 11275 Sprague Rd Delton MI 49046-8493 Ph: (269) 623-7121 |
| NPI Number | 1215048384 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 12/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215048384 | NPI | - | NPPES |
| 383530765 | Other | MI | TAX ID |
| 4639104 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101008208 (Michigan) | Primary |