Provider Demographics
NPI:1043940323
Name:LETS INC
Entity Type:Organization
Organization Name:LETS INC
Other - Org Name:JACKSON EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:740-577-3527
Mailing Address - Street 1:731 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-2100
Mailing Address - Country:US
Mailing Address - Phone:740-577-3527
Mailing Address - Fax:
Practice Address - Street 1:731 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-2100
Practice Address - Country:US
Practice Address - Phone:740-577-3527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000015Medicaid