| Job Jacob Md Pllc | |
|
965 Carson Cv Ste A Conway AR 72034 | |
| (501) 513-2628 | |
| (501) 513-2630 |
| Full Name | Job Jacob Md Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 965 Carson Cv Ste A, Conway, Arkansas |
| Authorized Official Name and Position | Job Jacob (OWNER) |
| Authorized Official Contact | 5015132628 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Job Jacob Md Pllc Po Box 10585 Conway AR 72034-0009 Ph: (501) 513-2628 | Job Jacob Md Pllc 965 Carson Cv Ste A Conway AR 72034 Ph: (501) 513-2628 |
| NPI Number | 1124152236 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 08/01/2018 |
| Medicare PECOS PAC ID | 8224177860 |
|---|---|
| Medicare Enrollment ID | O20091120000330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124152236 | NPI | - | NPPES |
| 161356002 | Medicaid | AR | |
| MC-2479 | Other | AR | STATE LICENSE PLLC NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | MC-2479 (Arkansas) | Primary |
| Provider Name | Job Jacob |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1053377101 PECOS PAC ID: 3870506728 Enrollment ID: I20060720000026 |
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