| Jdj Gastro Pllc | |
|
1915 S Main St Madisonville KY 42431-3353 | |
| (270) 344-5473 | |
| Not Available |
| Full Name | Jdj Gastro Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1915 S Main St, Madisonville, Kentucky |
| Authorized Official Name and Position | John Dacosta (OWNER) |
| Authorized Official Contact | 2703445473 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jdj Gastro Pllc 1915 S Main St Madisonville KY 42431-3353 Ph: () - | Jdj Gastro Pllc 1915 S Main St Madisonville KY 42431-3353 Ph: (270) 344-5473 |
| NPI Number | 1831956663 |
|---|---|
| Provider Enumeration Date | 02/28/2024 |
| Last Update Date | 03/20/2024 |
| Medicare PECOS PAC ID | 0648611608 |
|---|---|
| Medicare Enrollment ID | O20240508003920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831956663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | John A Dacosta |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1932133642 PECOS PAC ID: 1052355344 Enrollment ID: I20070212000590 |
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