Provider Demographics
NPI:1184814162
Name:SLOBODAN B JUGO PSC
Entity type:Organization
Organization Name:SLOBODAN B JUGO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SLOBODAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-338-6650
Mailing Address - Street 1:300 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1220
Mailing Address - Country:US
Mailing Address - Phone:270-338-6650
Mailing Address - Fax:270-338-6653
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1220
Practice Address - Country:US
Practice Address - Phone:270-338-6650
Practice Address - Fax:270-338-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212129Medicaid
C63620Medicare UPIN
KY64212129Medicaid