Healthcare Provider Details

I. General information

NPI: 1477465649
Provider Name (Legal Business Name): PANKEYS TABLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7899 CAMARGO RD
CINCINNATI OH
45243-2651
US

IV. Provider business mailing address

7672 MONTGOMERY RD STE 147
CINCINNATI OH
45236-4204
US

V. Phone/Fax

Practice location:
  • Phone: 513-807-8909
  • Fax:
Mailing address:
  • Phone: 513-807-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ANTHONY JONES
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 614-843-2941