MEDICARE: JPC MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E3472	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5F554	OTHER	AR	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5F554	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114974615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPC MEDICAL INC

Provider Business Mailing Address
First Line	:	1300 W. COURT ST.
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-4247
Country	:	US
Telephone Number	:	870-236-4100
Fax Number	:	870-236-4122

Provider Business Practice Location Address
First Line	:	1300 W. COURT ST.
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-4247
Country	:	US
Telephone Number	:	870-236-4100
Fax Number	:	870-236-4122

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOHN RAYMOND HINES
Credential	:	D.O.
Telephone Number	:	870-236-4100

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/07/2011

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Directions to “JPC MEDICAL INC ” Practice Location

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