Preston, Jack Michael

Preston, Jack Michael is an individual health care provider with primary practice located at 1000 Dutch Ridge Rd , Beaver PA 15009-9727. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Preston, Jack Michael can be contacted via phone (724) 773-4567.

Contact Information

Primary practice address
1000 Dutch Ridge Rd Beaver PA 15009-9727
Phone: (724) 773-4567
Fax: (724) 728-9729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD027545E Pennsylvania

Profile Details

NPI number 1689644031
LBN Legal business name Preston, Jack Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Apr 13th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689644031 NPPES
Pennsylvania MEDICAID 0009554740018
Pennsylvania MEDICAID 3810003945
Pennsylvania MEDICAID 000955474
Pennsylvania MEDICAID 2233292

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