Provider Demographics
NPI:1801112347
Name:JONATHAN ALLEY, D.O., P.C.
Entity type:Organization
Organization Name:JONATHAN ALLEY, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:260-665-5170
Mailing Address - Street 1:424 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1556
Mailing Address - Country:US
Mailing Address - Phone:260-665-5170
Mailing Address - Fax:260-665-6979
Practice Address - Street 1:424 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1556
Practice Address - Country:US
Practice Address - Phone:260-665-5170
Practice Address - Fax:260-665-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN020014D6A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000263260OtherBLUE SHIELD
IN4416561OtherAETNA
IN100225890AMedicaid
IN5463OtherPHP
INF51207Medicare UPIN
IN771350Medicare PIN