Provider Demographics
NPI:1891782389
Name:ZENTZ, JOSHUA (PAC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ZENTZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-7608
Mailing Address - Country:US
Mailing Address - Phone:812-932-3224
Mailing Address - Fax:812-932-3064
Practice Address - Street 1:295 WINDING WAY
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7608
Practice Address - Country:US
Practice Address - Phone:812-932-3224
Practice Address - Fax:812-932-3064
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000697A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA32011Medicare PIN
IN217350BMedicare PIN
IN217350Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER