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General NPI Number Information
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NPI Number | 1205050291
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Entity Type | Organization
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Legal Business Name | JAGEMAN & JAGEMAN MDS INC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4108 ZUCK RD
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City | ERIE
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State | PA
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Zip | 16506-4539
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Country | US
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Telephone | 814-838-3681
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Fax | 814-838-6620
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Provider Business Mailing Address
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Address Line | 4108 ZUCK RD
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City | ERIE
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State | PA
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Zip | 16506-4539
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Country | US
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Telephone | 814-838-3681
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Fax | 814-838-6620
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN C JAGEMAN
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Credential | MS
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Telephone | 814-838-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD015659E
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License Number State | PA
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