Provider Demographics
NPI:1184318677
Name:STAUFFER, AMOS JR
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:STAUFFER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:WILLSHIRE
Mailing Address - State:OH
Mailing Address - Zip Code:45898-0059
Mailing Address - Country:US
Mailing Address - Phone:567-510-7124
Mailing Address - Fax:
Practice Address - Street 1:509 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:WILLSHRE
Practice Address - State:OH
Practice Address - Zip Code:45898
Practice Address - Country:US
Practice Address - Phone:567-510-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider