JTDM FAMILY PRACTICE LLC (NPI# 1144257759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144257759 |
| Entity Type | Organization |
| Organization Name | JTDM FAMILY PRACTICE LLC |
| Other Organization Name | GRAND LAKE NEUROLOGY |
| Practice Address |
1165 S Knoxville Ave Suite F St Marys OH 45885-2622 |
| Mailing Address |
1165 S Knoxville Ave Suite F St. Marys OH 45885-2622 |
| Practice Telephone | 4193949340 |
| Practice Fax Number | 4193949342 |
| Mailing Telephone | 4193949340 |
| Mailing Fax Number | 4193949342 |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2014-01-03 |
| Authorized Official Name | JEFFREY W VOSSLER (VICE PRESIDENT OF FINANCIAL SERVICE) |
| Authorized Official Telephone | 4193943335 |
| Is Organization Subpart | Y |
| Parent Organization Name | JTDM FAMILY PRACTICE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2003049 | 05 | |
| OH | MEDICARE PTAN | 9934723 | 01 |
| Other Name | Type Code |
|---|---|
| Grand Lake Neurology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164602678 | Jtdm Family Practice LLC | Family Medicine | 4 Eagle Dr, Minster, OH 45865-9714 | 2007-11-13 |
| 1639114192 | Jtdm Family Practice LLC | Otolaryngology | 1165 S Knoxville Ave, Suite F, St Marys, OH 45885-2622 | 2006-06-18 |
| 1750937090 | Jtdm Family Practice LLC | Durable Medical Equipment & Medical Supplies | 1013 E Spring St, Saint Marys, OH 45885-2447 | 2019-08-13 |
| 1932670023 | Jtdm Family Practice LLC | Durable Medical Equipment & Medical Supplies | 123 Hamilton St, Celina, OH 45822-1909 | 2018-12-16 |
| 1356772255 | Jtdm Family Practice LLC | Family Medicine | 812 Redskin Trl, Wapakoneta, OH 45895-8545 | 2013-12-03 |
| 1689005761 | Jtdm Family Practice LLC | Physician Assistant | 801 Pro Dr, Celina, OH 45822-3307 | 2013-11-27 |
| 1942630348 | Jtdm Family Practice LLC | Pediatrics | 801 Pro Dr, Celina, OH 45822-3307 | 2013-11-21 |
| 1104024546 | Jtdm Family Practice LLC | Family Medicine | 4463 State Route 66, Minster, OH 45865-8727 | 2007-07-06 |
| 1447288717 | Jtdm Family Practice LLC | Obstetrics & Gynecology | 1067 Hager St, St Marys, OH 45885-2422 | 2006-06-28 |
| 1184652539 | Jtdm Family Practice LLC | Nurse Practitioner | 200 Saint Clair Ave, St Marys, OH 45885-2400 | 2006-06-28 |
| Street Address |
1165 S KNOXVILLE AVE SUITE F |
| City | ST MARYS |
| State | OH |
| Zip Code | 45885-2622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639114192 | Jtdm Family Practice LLC | Otolaryngology | 1165 S Knoxville Ave, Suite F, St Marys, OH 45885-2622 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083232417 | Dimensional Wellness LLC | Counselor | 150 1/2 E. High St., Saint Marys, OH 45885 | 2020-07-13 |
| 1124679519 | Wishing Well Clinic & Spa, LLC | Massage Therapist | 153 E, Spring Street, St Marys, OH 45885 | 2019-09-26 |
| 1720633639 | Grand Lake Operations, LLC | Assisted Living Facility | 1035 Hager Street, Saint Marys, OH 45885 | 2019-08-07 |
| 1225436439 | Sharon Schnell | Pharmacist | 200 St. Clair Ave, St. Marys, OH 45885 | 2014-12-22 |
| 1851692669 | Gregory J Walter | Pharmacist | 1052 E. Spring St., St. Marys, OH 45885 | 2010-11-10 |
| 1578708053 | St Marys City Board of Education | Local Education Agency (LEA) | 2250 State Route 66, Saint Marys, OH 45885 | 2008-12-11 |
| 1104098037 | Alliance for Women's Health Inc | Obstetrics & Gynecology | 510 East Spring Street, St Marys, OH 45885 | 2008-04-01 |
| 1598869646 | Pajka Eye Center Inc | Ophthalmology | 200 St Clair, Joint Township District Memorial Hospital, St Marys, OH 45885 | 2006-09-11 |
| 1487664306 | Chalasani Md Inc. | Internal Medicine | 1300 Greenville Rd., St. Marys, OH 45885 | 2006-08-09 |
| 1821007949 | Kenneth Lance Bryant | Surgery | 1300 Greenville Rd Ste B, Saint Marys, OH 45885 | 2006-08-07 |
| Find all providers in zip 45885 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932721305 | Stephen P Fuqua | Psychiatry & Neurology | 30 E Apple St # 5254, Dayton, OH 45409-2939 | 2020-05-08 |
| 1972145431 | Columbus Neuroscience LLC | Psychiatry & Neurology | 450 Alkyre Run Ste 350, Westerville, OH 43082-6912 | 2019-10-16 |
| 1538632641 | Premier Neurology LLC | Psychiatry & Neurology | 1730 W 25th St Ste 3a, Cleveland, OH 44113-3108 | 2019-01-10 |
| 1285112862 | Andrew Kuntz | Psychiatry & Neurology | 1611 S Green Rd Ste 141, South Euclid, OH 44121-4121 | 2018-08-05 |
| 1174059174 | Padet Wattanasarn | Psychiatry & Neurology | 1070 Circle On The Grn, Columbus, OH 43235-1211 | 2017-05-11 |
| 1184075491 | Marek Cierny | Psychiatry & Neurology | 9500 Euclid Ave # S80, Cleveland, OH 44195-3522 | 2016-06-28 |
| 1952751471 | Mohamed Ridha | Psychiatry & Neurology | 260 Stetson Street Suite 2300, Mail Location 0525, Cincinnati, OH 45267-1552 | 2016-06-15 |
| 1508246422 | Rachel Pan | Psychiatry & Neurology | 135 N Ewing St Ste 204, Lancaster, OH 43130-3378 | 2015-06-05 |
| 1477940369 | Robert Joseph Stanton II | Psychiatry & Neurology | 3130 Highland Ave Fl 2, Uc Health Neurology Clinic, Cincinnati, OH 45219-2399 | 2015-04-20 |
| 1831591510 | Patrick Chauvel | Psychiatry & Neurology | Cleveland Clinic Epilepsy Ctr, 9500 Euclid Avenue, Cleveland, OH 44195-0001 | 2014-09-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JTDM FAMILY PRACTICE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.