MEDICARE: JBS DIAGNOSTICS, LLC

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427522580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBS DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	9098 PARAGON WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5112
Country	:	US
Telephone Number	:	561-502-6289
Fax Number	:	561-491-5519

Provider Business Practice Location Address
First Line	:	3020 HIGH RIDGE RD STE 600
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8731
Country	:	US
Telephone Number	:	561-502-6289
Fax Number	:	561-491-5519

Authorized Official
Title or Position	:	/SECRETARYTREASURER
Name	:	MR. JEAN SAMUEL SANON
Credential	:
Telephone Number	:	561-502-6289

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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