Provider Demographics
NPI:1326789389
Name:ARMENTROUT, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ARMENTROUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45359-9723
Mailing Address - Country:US
Mailing Address - Phone:937-216-7794
Mailing Address - Fax:
Practice Address - Street 1:375 N RANGELINE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OH
Practice Address - Zip Code:45359-9723
Practice Address - Country:US
Practice Address - Phone:937-216-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259251Medicaid