JCR DO PLC
Organization Active NPI Family Medicine Physician · Delton, MI
NPI 1215048384 · NPPES record last updated Dec 15, 2008
Key facts
- NPI
- 1215048384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101008208 (MI)
- Legal business name
- JCR DO PLC
- Practice address
- 11275 Sprague Rd
Delton, MI 49046-8493 - Phone
- (269) 623-7121
- Fax
- (269) 623-5527
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Joseph C. Roth, D.O.
- Title
- Owner
- Phone
- (269) 623-7121
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 5101008208 | MI | Yes |
Addresses
Primary practice location
11275 Sprague Rd
Delton, MI 49046-8493
Mailing address
11275 Sprague Rd
Delton, MI 49046-8493
Phone (269) 623-7121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 383530765 | Other | MI | TAX ID |
| 4639104 | Medicaid | MI |
Other names
- Delton Medical Center
Other providers in Delton, MI
- Delton Family Pharmacy
- Delton Family Pharmacy Inc
- Delton Family Pharmacy Inc
- Lyndsay Elyse Eckhart
- Sallie Mae Emert
- John D Kehl
- Tyler Koerth
- Logan Dakota Lockridge
- Mary A Martin
- Deborah Lynn Pace
All providers in Delton, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.