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Organization
PROVECTUS LTC LLC
Active
Organization
PROVECTUS LTC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIRK N JUSCHKA (MD)
(937) 402-1000
Entity
Organization
Contact information
Practice address
300 W SPRING ST UNIT 702, COLUMBUS, OH 43215-7651
(937) 402-1000
Mailing address
PO BOX 609, LUCASVILLE, OH 45648-0609
(937) 402-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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