| Machuca Medical Llc | |
|
7371 Brandt Pike Ste D Huber Heights OH 45424-3276 | |
| (937) 795-1101 | |
| (937) 795-1120 |
| Full Name | Machuca Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7371 Brandt Pike Ste D, Huber Heights, Ohio |
| Authorized Official Name and Position | Jennifer Lynn Machuca (SOLO PHYSICIAN IN GROUP NPI) |
| Authorized Official Contact | 9377951101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Machuca Medical Llc 7371 Brandt Pike Suite D Huber Heights OH 45424 Ph: (937) 795-1101 | Machuca Medical Llc 7371 Brandt Pike Ste D Huber Heights OH 45424-3276 Ph: (937) 795-1101 |
| NPI Number | 1053861369 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 05/19/2025 |
| Medicare PECOS PAC ID | 5193070779 |
|---|---|
| Medicare Enrollment ID | O20180622000987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053861369 | NPI | - | NPPES |
| 1669694246 | Other | INDIVIDUAL NPI | |
| 1053861369 | Other | GROUP NPI | |
| H598960 | Other | PTAN | |
| MA4253051 | Other | LEGACY | |
| 2893301 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | 92123 (Ohio) | Primary |
| Provider Name | Jennifer L Machuca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669694246 PECOS PAC ID: 9537224654 Enrollment ID: I20090224000314 |
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