MEDICARE: JACK OLIVER JR.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851155766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK OLIVER JR.

Provider Business Mailing Address
First Line	:	1754 CIRCLE DR SW
Second Line	:
City	:	NEW PHILA
State	:	OH
Zip	:	44663-7503
Country	:	US
Telephone Number	:	330-205-2348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 CIRCLE DR SW
Second Line	:
City	:	NEW PHILA
State	:	OH
Zip	:	44663-7503
Country	:	US
Telephone Number	:	330-205-2348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	09/27/2024

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Directions to “ JACK OLIVER JR. ” Practice Location

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