Healthcare Provider Details

I. General information

NPI: 1417882580
Provider Name (Legal Business Name): JMJ SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5774 RAPALLO DR
WEST LAFAYETTE IN
47906-8967
US

IV. Provider business mailing address

5774 RAPALLO DR
WEST LAFAYETTE IN
47906-8967
US

V. Phone/Fax

Practice location:
  • Phone: 214-541-4853
  • Fax:
Mailing address:
  • Phone: 214-541-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAMES ALEX
Title or Position: SURGICAL FIRST ASSIST
Credential: CSFA
Phone: 214-541-4853