| Jonathan Alley, D.O., P.C. | |
|
424 Williams St Angola IN 46703-1556 | |
| (260) 665-5170 | |
| (260) 665-6979 |
| Full Name | Jonathan Alley, D.O., P.C. |
|---|---|
| Speciality | Family Medicine |
| Location | 424 Williams St, Angola, Indiana |
| Authorized Official Name and Position | Jonathan E Alley (OWNER) |
| Authorized Official Contact | 2606655170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan Alley, D.O., P.C. 424 Williams St Angola IN 46703-1556 Ph: (260) 665-5170 | Jonathan Alley, D.O., P.C. 424 Williams St Angola IN 46703-1556 Ph: (260) 665-5170 |
| NPI Number | 1801112347 |
|---|---|
| Provider Enumeration Date | 04/08/2010 |
| Last Update Date | 04/09/2024 |
| Certification Date | 04/09/2024 |
| Medicare PECOS PAC ID | 7618004094 |
|---|---|
| Medicare Enrollment ID | O20100415000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801112347 | NPI | - | NPPES |
| 000000263260 | Other | IN | BLUE SHIELD |
| 4416561 | Other | IN | AETNA |
| 100225890A | Medicaid | IN | |
| 5463 | Other | IN | PHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 020014D6A (Indiana) | Primary |
| Provider Name | Jonathan E Alley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083672919 PECOS PAC ID: 1355342247 Enrollment ID: I20080606000017 |
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