MEDICARE: JMP FAMILY PRACTICE INCORPORATED

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1740626621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMP FAMILY PRACTICE INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 290192
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-0004
Country	:	US
Telephone Number	:	803-787-3901
Fax Number	:	803-787-3902

Provider Business Practice Location Address
First Line	:	3304 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4024
Country	:	US
Telephone Number	:	803-787-3901
Fax Number	:	803-787-3902

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DAWN RICHARDSON
Credential	:
Telephone Number	:	803-386-6374

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	05/17/2013

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