Provider Demographics
NPI:1972796472
Name:JAMESON MEDICAL CARE INC
Entity Type:Organization
Organization Name:JAMESON MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-658-9001
Mailing Address - Street 1:PO BOX 14397
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7397
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:1211 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2516
Practice Address - Country:US
Practice Address - Phone:724-658-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002007025OtherBLUE SHIELD
PA002007029OtherBLUE SHIELD
PA002007035OtherBLUE SHIELD
PA0011868740001Medicaid
PA002007032OtherBLUE SHIELD
PA002007032OtherBLUE SHIELD