Provider Demographics
NPI:1902309040
Name:SAILOR, JASON KIRK
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:KIRK
Last Name:SAILOR
Suffix:
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 1:910 N HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1808
Mailing Address - Country:US
Mailing Address - Phone:517-402-8378
Mailing Address - Fax:
Practice Address - Street 1:11410 E LENNON RD
Practice Address - Street 2:
Practice Address - City:LENNON
Practice Address - State:MI
Practice Address - Zip Code:48449-9666
Practice Address - Country:US
Practice Address - Phone:810-621-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant