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General NPI Number Information
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NPI Number | 1053765602
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL J JURENOVICH, D.O., PC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 456 S MAIN ST
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City | ANDOVER
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State | OH
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Zip | 44003-9496
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Country | US
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Telephone | 724-456-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 59 W MAIN ST
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City | GREENVILLE
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State | PA
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Zip | 16125-2449
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Country | US
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Telephone | 724-588-4805
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Fax | 724-588-4909
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Authorized Official
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Title or Position | CLINIC ASSISTANT / OFFICE ASSISTANT
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Name | KATHY JAYNE ADAMS
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Credential |
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Telephone | 724-813-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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