MEDICARE: JANTZ FAMILY PRACTICE PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1649827197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANTZ FAMILY PRACTICE PLLC

Provider Business Mailing Address
First Line	:	201 SIGNATURE PL STE 103
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3377
Country	:	US
Telephone Number	:	615-257-7778
Fax Number	:	615-235-3660

Provider Business Practice Location Address
First Line	:	201 SIGNATURE PL STE 103
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3377
Country	:	US
Telephone Number	:	615-257-7778
Fax Number	:	615-235-3660

Authorized Official
Title or Position	:	PA/OWNER
Name	:	STEVEN PACK
Credential	:	PA
Telephone Number	:	615-257-7778

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	02/20/2026

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