Healthcare Provider Details

I. General information

NPI: 1841621026
Provider Name (Legal Business Name): JC-PC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N TRAVIS AVE
CAMERON TX
76520-1665
US

IV. Provider business mailing address

PO BOX 795
CAMERON TX
76520-0795
US

V. Phone/Fax

Practice location:
  • Phone: 254-697-6564
  • Fax:
Mailing address:
  • Phone: 254-697-8455
  • Fax: 254-697-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number136902
License Number StateTX

VIII. Authorized Official

Name: MR. JAMES D CAMP
Title or Position: PRES., JC-PC,INC
Credential:
Phone: 254-697-6564