NPIMap

Organization Active NPI

Jack Siebenaler II MD, Inc

  • Primary Care Clinic/Center
  • Oregon, OH
National Provider Identifier
1255514873
Registry record updated Feb 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
350535801S Issued in OH
Legal business name
JACK SIEBENALER II MD, INC
Practice address
3232 Navarre Ave
Oregon, OH 43616-3312
Phone
(419) 691-0636
Fax
(419) 693-1412
NPI assigned
Dec 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack G Siebenaler II, MDNPI 1982670212
Title
Owner
Phone
(419) 691-0636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 350535801S OH Primary

Addresses

Primary practice location

3232 Navarre Ave
Oregon, OH 43616-3312

Mailing address

3232 Navarre Ave
Oregon, OH 43616-3312
Phone (419) 691-0636

Other identifiers 1

IdentifierTypeStateIssuer
0056057MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Jack Siebenaler II MD Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1255514873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163312",
            "telephone_number": "419-691-0636",
            "fax_number": "419-693-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163312",
            "telephone_number": "419-691-0636",
            "fax_number": "419-693-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK SIEBENALER II MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "SIEBENALER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-691-0636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OH",
            "license": "350535801S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056057",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.