Healthcare Provider Details

I. General information

NPI: 1508740507
Provider Name (Legal Business Name): JBH PRIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 CITATION DR
COLUMBIA MO
65202-4832
US

IV. Provider business mailing address

3713 CITATION DR
COLUMBIA MO
65202-4832
US

V. Phone/Fax

Practice location:
  • Phone: 573-217-4908
  • Fax: 855-857-8425
Mailing address:
  • Phone: 573-217-4908
  • Fax: 855-857-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYNNE BROCKMAN
Title or Position: OWNER/ DAILY OPERATIONS MANAGER
Credential: CPT
Phone: 314-397-9004