=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194955658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON ADAMS ALLEN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2009
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 W UNION ST STE B
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-566-4850
-----------------------------------------------------
Fax | 740-566-4751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5450 FRANTZ RD STE 360
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43016-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-544-6155
-----------------------------------------------------
Fax | 614-544-6370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 34011483
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 34011483
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------