Provider Demographics
NPI:1902250558
Name:DR. MICHAEL J JURENOVICH, D.O., PC
Entity Type:Organization
Organization Name:DR. MICHAEL J JURENOVICH, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ASSISTANT / OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-813-5611
Mailing Address - Street 1:59 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2449
Mailing Address - Country:US
Mailing Address - Phone:724-588-4805
Mailing Address - Fax:724-588-4809
Practice Address - Street 1:654 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4356
Practice Address - Country:US
Practice Address - Phone:330-544-5782
Practice Address - Fax:330-505-2286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MICHAEL J JURENOVICH, D.O., PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHXM9313351Medicare PIN