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NPI Code Detail

MEDICARE: JACOB SPENCER

MEDICARE: JACOB SPENCER
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1972359222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB SPENCER
Provider Business Mailing Address
First Line : 5109 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-1648
Country : US
Telephone Number : 614-544-1976
Fax Number :
Provider Business Practice Location Address
First Line : 5109 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-1648
Country : US
Telephone Number : 614-544-1976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2024
Last Update Date : 03/24/2026

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Directions to “ JACOB SPENCER ” Practice Location

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