MEDICARE: JMC 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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1437656741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMC LLC

Provider Business Mailing Address
First Line	:	800 HAZLETT AVE
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6933
Country	:	US
Telephone Number	:	304-905-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 HAZLETT AVE
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6933
Country	:	US
Telephone Number	:	304-905-8797
Fax Number	:

Authorized Official
Title or Position	:	CCM
Name	:	MR. JASON PETTRESS
Credential	:
Telephone Number	:	304-905-8797

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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Directions to “JMC LLC ” Practice Location

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