Healthcare Provider Details

I. General information

NPI: 1114522182
Provider Name (Legal Business Name): JERNEKY BILLING & CODING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 NW 162ND ST
OPA LOCKA FL
33054-6541
US

IV. Provider business mailing address

2415 NW 162ND ST
OPA LOCKA FL
33054-6541
US

V. Phone/Fax

Practice location:
  • Phone: 786-812-2578
  • Fax:
Mailing address:
  • Phone: 786-812-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierL525178789180
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: DE MIA LONGCHAMP
Title or Position: BILLING SPECIALIST
Credential: CCS
Phone: 786-812-2578