Provider Demographics
NPI:1295860229
Name:D. SUZI JAGODITZ
Entity Type:Organization
Organization Name:D. SUZI JAGODITZ
Other - Org Name:JAG'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D.SUZI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGODITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-829-8988
Mailing Address - Street 1:630 NILLES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-829-8988
Mailing Address - Fax:513-829-8988
Practice Address - Street 1:630 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-829-8988
Practice Address - Fax:513-829-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000253723OtherANTHEM PIN
OH57718OtherNORTHWOOD NPN PIN
OH000000253723OtherANTHEM PIN