MEDICARE: DARICK L JACOBS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35086103	OH
2	2085R0204X	Vascular & Interventional Radiology Physician	35.086103	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00248945	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386624047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARICK L JACOBS M.D.

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-8315
Fax Number	:	614-293-6935

Provider Business Practice Location Address
First Line	:	395 W 12TH AVE RM 460
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-293-8315
Fax Number	:	614-293-6935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	06/24/2024

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Directions to “ DARICK L JACOBS M.D.” Practice Location

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