Healthcare Provider Details

I. General information

NPI: 1588396105
Provider Name (Legal Business Name): JPS INTERNATIONAL SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 MAGNOLIA BLOSSOM CIR
CLERMONT FL
34711-7522
US

IV. Provider business mailing address

2916 MAGNOLIA BLOSSOM CIR
CLERMONT FL
34711-7522
US

V. Phone/Fax

Practice location:
  • Phone: 352-678-9472
  • Fax:
Mailing address:
  • Phone: 352-678-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JAY PETERS
Title or Position: MBR
Credential: PHLEBOTOMIST
Phone: 352-678-9472