Basic Information
| Provider Information | |||||||||
| NPI: | 1952394348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHNE | ||||||||
| FirstName: | JED | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 S KNOXVILLE AVE STE D | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458852609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193001129 | ||||||||
| FaxNumber: | 4195861257 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 HAMILTON ST | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458221909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195865760 | ||||||||
| FaxNumber: | 4195861257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50002151 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1184652539 | 01 | OH | GROUP NPI | OTHER | 0105065 | 01 | OH | GROUP MEDICAID | OTHER | 0216503 | 05 | OH | MEDICAID | 34-1689161 | 01 | OH | TAX ID | OTHER | 9934723 | 01 | OH | GROUP MEDICARE | OTHER | H546170 | 01 | OH | MEDICARE | OTHER |