# FAMILY PRACTICE OF JAY COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JAY COUNTY HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982749867
- **Legal business name:** JAY COUNTY HOSPITAL
- **Authorized official:** DR. MARK ALLEN HAGGENJOS D.O. (MANAGING PHYSICIAN)
- **Authorized official phone:** (260) 726-8822

## Contact information

- **Practice address:** 428 WEST VOTAW STREET, STE. A, PORTLAND, IN 47371-0710
- **Practice address phone:** (260) 726-8822
- **Practice address fax:** (260) 726-7857
- **Mailing address:** PO BOX 710, PORTLAND, IN 47371-0710
- **Mailing address phone:** (260) 726-8822
- **Mailing address fax:** (260) 726-7857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 09/23/2010