Healthcare Provider Details

I. General information

NPI: 1003249764
Provider Name (Legal Business Name): JBM HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-8714
US

IV. Provider business mailing address

355 ALLISON AVE
DAVENPORT FL
33897-5405
US

V. Phone/Fax

Practice location:
  • Phone: 863-512-4385
  • Fax:
Mailing address:
  • Phone: 863-512-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN326
License Number StateFL

VIII. Authorized Official

Name: DR. BENJAMIN MORENO
Title or Position: OWNER
Credential: MD
Phone: 863-512-4385