Provider Demographics
NPI:1649730581
Name:JEFFREY J. HAGGENJOS, D.O., INC
Entity type:Organization
Organization Name:JEFFREY J. HAGGENJOS, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROVATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-343-4447
Mailing Address - Street 1:399 LINCOLN PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1078
Mailing Address - Country:US
Mailing Address - Phone:740-343-4447
Mailing Address - Fax:740-343-4451
Practice Address - Street 1:399 LINCOLN PARK DR STE A
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1078
Practice Address - Country:US
Practice Address - Phone:740-343-4447
Practice Address - Fax:740-343-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty