| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 109 Linwood Dr, Rio Grande, Ohio |
| Authorized Official Name and Position | Brett Allen Jones (NURSE PRACTITIONER) |
| Authorized Official Contact | 7075060433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 312 Rio Grande OH 45674-0312 Ph: (740) 645-5755 | 109 Linwood Dr Rio Grande OH 45674 Ph: (707) 506-0433 |
| NPI Number | 1750152476 |
|---|---|
| Provider Enumeration Date | 01/11/2024 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Medicare PECOS PAC ID | 6608228242 |
|---|---|
| Medicare Enrollment ID | O20240118003063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750152476 | NPI | - | NPPES |
| 0328211 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Brett Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699240119 PECOS PAC ID: 0244577591 Enrollment ID: I20190124003427 |