Healthcare Provider Details

I. General information

NPI: 1780661835
Provider Name (Legal Business Name): JACK EVERETT HAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIN ST
OBERLIN OH
44074-1743
US

IV. Provider business mailing address

530 S MAIN ST
OBERLIN OH
44074-1743
US

V. Phone/Fax

Practice location:
  • Phone: 440-707-6247
  • Fax: 888-450-1239
Mailing address:
  • Phone: 440-707-6247
  • Fax: 888-450-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34008419
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number34008419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: