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Organization
FAMILY PRACTICE OF JAY COUNTY
Active
Organization
FAMILY PRACTICE OF JAY COUNTY
Active
Parent organization
JAY COUNTY HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
JAY COUNTY HOSPITAL
Authorized official
DR. MARK ALLEN HAGGENJOS D.O. (MANAGING PHYSICIAN)
(260) 726-8822
Entity
Organization
Contact information
Practice address
428 WEST VOTAW STREET, STE. A, PORTLAND, IN 47371-0710
(260) 726-8822
(260) 726-7857
Mailing address
PO BOX 710, PORTLAND, IN 47371-0710
(260) 726-8822
(260) 726-7857
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
09/23/2010
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