Organization
MACHUCA MEDICAL LLC
Active
Other names
Machuca Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER LYNN MACHUCA MD (OWNER/ SOLO PHYSICIAN)
(937) 795-1101
Entity
Organization
Contact information
Practice address
8648 OLD TROY PIKE STE A, HUBER HEIGHTS, OH 45424-1057
(937) 795-1101
(937) 795-1120
Mailing address
8648 OLD TROY PIKE STE A, HUBER HEIGHTS, OH 45424-1057
(937) 795-1101
(937) 795-1120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
92123
OH
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193739
—
OH
01
—
1053861369
GROUP NPI
—
01
—
1669694246
INDIVIDUAL NPI
—
05
—
2893301
—
OH
05
—
CS1721200142
—
OH
05
—
CS1721200145
—
OH
01
—
H59861
OTHER
OH
01
—
H598960
PTAN
—
01
—
MA4253051
LEGACY
—
Enumeration date
10/11/2016
Last updated
05/13/2026
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