Provider Demographics
NPI:1851346118
Name:SAVILL, JENNIFER N (PAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SAVILL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 150B
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-227-7117
Practice Address - Fax:419-227-2848
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069112Medicaid
CHPA23911Medicare PIN
OHSAPA23911Medicare PIN
Q29710Medicare UPIN