Basic Information
| Provider Information | |||||||||
| NPI: | 1568688687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CO | ||||||||
| FirstName: | JEANNIE | ||||||||
| MiddleName: | PO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2379 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411052379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064086200 | ||||||||
| FaxNumber: | 6064085338 | ||||||||
| Practice Location | |||||||||
| Address1: | 5775 N MEADOWS DR STE D | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431237300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142244200 | ||||||||
| FaxNumber: | 6142244207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43916 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 43916 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 35.099404 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 7100164770 | 05 | KY | MEDICAID | 3810020217 | 05 | WV | MEDICAID | 932670 | 01 | AETNA | OTHER | 000000726032 | 01 | KY | ANTHEM BCBS | OTHER | P01045712 | 01 | KY | RAILROAD MEDICARE | OTHER | 3148178 | 05 | OH | MEDICAID |