Healthcare Provider Details

I. General information

NPI: 1184619082
Provider Name (Legal Business Name): JPS PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST PHYSICIAN SERVICES
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

PO BOX 911294 PHYSICIAN SERVICES
DALLAS TX
75391-1294
US

V. Phone/Fax

Practice location:
  • Phone: 817-852-8440
  • Fax: 817-852-8432
Mailing address:
  • Phone: 817-852-8440
  • Fax: 817-852-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. PATTY ANGELL
Title or Position: DIRECTOR
Credential:
Phone: 817-852-8440