Basic Information
| Provider Information | |||||||||
| NPI: | 1801811559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY VAN METER MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1821 | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437021821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404559788 | ||||||||
| FaxNumber: | 7404553686 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437839750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407432464 | ||||||||
| FaxNumber: | 7407432346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | VAN METER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7407432464 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 35069196 | 01 | OH | OHIO LICENSE NUMBER | OTHER | 2041614 | 05 | OH | MEDICAID |