Healthcare Provider Details

I. General information

NPI: 1245620756
Provider Name (Legal Business Name): JM FAMILY ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 BAYBERRY RD
JACKSONVILLE FL
32256-7411
US

IV. Provider business mailing address

111 JIM MORAN BLVD
DEERFIELD BEACH FL
33442-1701
US

V. Phone/Fax

Practice location:
  • Phone: 904-443-6647
  • Fax: 904-443-6621
Mailing address:
  • Phone: 954-429-2418
  • Fax: 954-429-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ED BROWN
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 954-596-3976