Organization
JACKSON-VINTON COMMUNITY ACTION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL THIESSEN (EXECUTIVE DIRECTOR)
(740) 384-3722
Entity
Organization
Contact information
Practice address
118 S NEW YORK AVE, WELLSTON, OH 45692-1540
(740) 384-3722
(740) 384-5405
Mailing address
118 S NEW YORK AVE, WELLSTON, OH 45692-1540
(740) 384-3722
(740) 384-5405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0319113
—
OH
Enumeration date
06/18/2006
Last updated
08/22/2020
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