Healthcare Provider Details

I. General information

NPI: 1093344376
Provider Name (Legal Business Name): JUPITER MEDICAL CENTER PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S OLD DIXIE HWY STE 101
JUPITER FL
33458-7202
US

IV. Provider business mailing address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

V. Phone/Fax

Practice location:
  • Phone: 561-852-0038
  • Fax:
Mailing address:
  • Phone: 561-263-7411
  • Fax: 561-263-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY J BARTON
Title or Position: MANAGER, MANAGED CARE
Credential:
Phone: 561-263-7411