MEDICARE: JCR MEDICAL COORDINATION, 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1407165103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCR MEDICAL COORDINATION, INC.

Provider Business Mailing Address
First Line	:	5400 S UNIVERSITY DR
Second Line	:	BLD. J401
City	:	DAVIE
State	:	FL
Zip	:	33328-5312
Country	:	US
Telephone Number	:	954-835-5543
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 S UNIVERSITY DR
Second Line	:	BLD. J401
City	:	DAVIE
State	:	FL
Zip	:	33328-5312
Country	:	US
Telephone Number	:	954-835-5543
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN A PEREZ
Credential	:
Telephone Number	:	954-835-5543

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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