Basic Information
| Provider Information | |||||||||
| NPI: | 1073830535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JDC MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 COURT DR | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437016456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404541248 | ||||||||
| FaxNumber: | 7404548183 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437649749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403425158 | ||||||||
| FaxNumber: | 7403426702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNMYER | ||||||||
| AuthorizedOfficialFirstName: | SHELLY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 7404541248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35075041D | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.