Provider Demographics
NPI:1922252782
Name:JILL M. FOX, MD, INC
Entity Type:Organization
Organization Name:JILL M. FOX, MD, INC
Other - Org Name:KEY LIFE DIRECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:JESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-662-5555
Mailing Address - Street 1:1200 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1406
Mailing Address - Country:US
Mailing Address - Phone:419-662-5555
Mailing Address - Fax:419-662-5547
Practice Address - Street 1:1200 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1406
Practice Address - Country:US
Practice Address - Phone:419-662-5555
Practice Address - Fax:419-662-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3506427F2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJI9303722Medicare UPIN
OH93003721Medicare PIN