Provider Demographics
NPI:1649827197
Name:JANTZ FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:JANTZ FAMILY PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:615-257-7778
Mailing Address - Street 1:201 SIGNATURE PL STE 103
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3377
Mailing Address - Country:US
Mailing Address - Phone:615-257-7778
Mailing Address - Fax:615-235-3660
Practice Address - Street 1:201 SIGNATURE PL STE 103
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3377
Practice Address - Country:US
Practice Address - Phone:615-257-7778
Practice Address - Fax:615-235-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty