| Jackson Family Practice LLC | |
|
500 Burlington Rd Suite 260 Jackson OH 45640-9360 | |
| (740) 577-9181 | |
| (740) 577-9214 |
| Full Name | Jackson Family Practice LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 500 Burlington Rd, Jackson, Ohio |
| Authorized Official Name and Position | Maryann Hartwick (PRACTICE MANAGER) |
| Authorized Official Contact | 7405779181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Family Practice LLC Po Box 190 Jackson OH 45640-0190 Ph: (740) 577-9181 | Jackson Family Practice LLC 500 Burlington Rd Suite 260 Jackson OH 45640-9360 Ph: (740) 577-9181 |
| NPI Number | 1467819920 |
|---|---|
| Provider Enumeration Date | 01/28/2016 |
| Last Update Date | 03/24/2016 |
| Medicare PECOS PAC ID | 9234435249 |
|---|---|
| Medicare Enrollment ID | O20160316001908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467819920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Russell a Hartwick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235116583 PECOS PAC ID: 6103820618 Enrollment ID: I20060914000005 |
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