NPI 1063876076

Petre-Jo LLC

Organisation Preferred Provider Organization Madison, TN

Practice location

Address: 607 W Due West Ave STE 95, Madison, TN 37115-4415
Phone: (615) 982-8081
Mailing address: 858 Harbour Greens Pl, Sparta, TN 38583-4294

Authorised official

Name: Peter Konecny
Title: Managing Member
Phone: (931) 761-0410

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence L000000017166 (TN)

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Registry record

NPI: 1063876076
Entity type: Organization
NPI issued: 6 Apr 2016
Record last updated: 6 Apr 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.