MEDICARE: JACQUELINE AMATO MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	22816	OR

General Provider Information

NPI Number	:	1215447008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE AMATO MD PC

Provider Business Mailing Address
First Line	:	841 ALDER CREEK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8900
Country	:	US
Telephone Number	:	541-858-7188
Fax Number	:	541-858-7186

Provider Business Practice Location Address
First Line	:	841 ALDER CREEK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8900
Country	:	US
Telephone Number	:	541-858-7188
Fax Number	:	541-858-7186

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBBIE JEWELL
Credential	:
Telephone Number	:	541-858-7188

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	10/18/2023

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