Healthcare Provider Details

I. General information

NPI: 1386035368
Provider Name (Legal Business Name): J M HOLDING GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 S SCATTERFIELD RD STE A
ANDERSON IN
46016-5785
US

IV. Provider business mailing address

1541 S SCATTERFIELD RD STE A
ANDERSON IN
46016-5785
US

V. Phone/Fax

Practice location:
  • Phone: 765-649-1991
  • Fax: 765-649-3383
Mailing address:
  • Phone: 765-649-1991
  • Fax: 765-649-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateIN

VIII. Authorized Official

Name: ASHLEY FERRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 765-649-1991