Provider Demographics
NPI:1003652801
Name:JMAC MEDICAL
Entity type:Organization
Organization Name:JMAC MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-241-3321
Mailing Address - Street 1:15704 REIMUND CT
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8902
Mailing Address - Country:US
Mailing Address - Phone:219-241-3321
Mailing Address - Fax:
Practice Address - Street 1:1715 INDIAN WOOD CIRCLE
Practice Address - Street 2:SUITE 282
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:219-241-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36.004044OtherOHIO ELICENSE PROFESSIONAL LICENSURE
OH0462302Medicaid