MEDICARE: ERIC JAKE JURECKY

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699602417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JAKE JURECKY

Provider Business Mailing Address
First Line	:	1924 FOREST RIDGE DR STE 100
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-8226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 FOREST RIDGE DR
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-8228
Country	:	US
Telephone Number	:	817-381-0538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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