| Dr. Dirk LLC | |
|
300 W Spring St Unit 702 Columbus OH 43215-7651 | |
| (937) 232-8033 | |
| (937) 426-6576 |
| Full Name | Dr. Dirk LLC |
|---|---|
| Speciality | Skilled Nursing Facility |
| Location | 300 W Spring St Unit 702, Columbus, Ohio |
| Authorized Official Name and Position | Dirk Norman Juschka (CEO) |
| Authorized Official Contact | 9374021000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Dirk LLC Po Box 609 Lucasville OH 45648-0609 | Dr. Dirk LLC 300 W Spring St Unit 702 Columbus OH 43215-7651 Ph: (937) 232-8033 |
| NPI Number | 1801189592 |
|---|---|
| Provider Enumeration Date | 05/27/2011 |
| Last Update Date | 11/23/2021 |
| Certification Date | 11/23/2021 |
| Medicare PECOS PAC ID | 4880862796 |
|---|---|
| Medicare Enrollment ID | O20110720000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801189592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Secondary |
| 314000000X | Skilled Nursing Facility | 35.052815 (Ohio) | Primary |
| Provider Name | Dirk N Juschka |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1497750137 PECOS PAC ID: 5698738946 Enrollment ID: I20041108000505 |
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