Provider Demographics
NPI:1205848744
Name:MICHAEL J JURENOVICH DOPC
Entity Type:Organization
Organization Name:MICHAEL J JURENOVICH DOPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JURENOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-588-4805
Mailing Address - Street 1:59 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2449
Mailing Address - Country:US
Mailing Address - Phone:724-588-4805
Mailing Address - Fax:724-588-4809
Practice Address - Street 1:59 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2449
Practice Address - Country:US
Practice Address - Phone:724-588-4805
Practice Address - Fax:724-588-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012030900001Medicaid
PACB4986Medicare PIN
PA000631278Medicare PIN
A15862Medicare UPIN
OH9313351Medicare PIN