Healthcare Provider Details

I. General information

NPI: 1417311341
Provider Name (Legal Business Name): JMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26, MEYOTTE 35
PETION VILLE PORT-AU-PRINCE
6120
HT

IV. Provider business mailing address

26, MEYOTTE 35
PETION VILLE PORT-AU-PRINCE
6120
HT

V. Phone/Fax

Practice location:
  • Phone: 239-676-4132
  • Fax:
Mailing address:
  • Phone: 239-676-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JORGENSEN
Title or Position: POINT OF CONTACT
Credential: MD
Phone: 305-575-7000