MEDICARE: JCP MEDICAL PA

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	111N00000X	Chiropractor	CH0003028	FL
2	207Q00000X	Family Medicine Physician	OS7123	FL

General Provider Information

NPI Number	:	1316221435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCP MEDICAL PA

Provider Business Mailing Address
First Line	:	3749 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4104
Country	:	US
Telephone Number	:	305-420-5229
Fax Number	:	786-207-2668

Provider Business Practice Location Address
First Line	:	3749 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4104
Country	:	US
Telephone Number	:	305-420-5229
Fax Number	:	786-207-2668

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES PADULA
Credential	:	DO
Telephone Number	:	305-420-5229

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/28/2011

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Directions to “JCP MEDICAL PA ” Practice Location

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