Healthcare Provider Details

I. General information

NPI: 1962460428
Provider Name (Legal Business Name): JSM ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD STE. 250
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

PO BOX 796002
SAINT LOUIS MO
63179-6000
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-4449
  • Fax: 314-567-0762
Mailing address:
  • Phone: 314-567-4449
  • Fax: 314-567-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON MODICA
Title or Position: OWNER
Credential:
Phone: 314-567-5445