Healthcare Provider Details

I. General information

NPI: 1477799518
Provider Name (Legal Business Name): JPS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

1608 STONELEIGH CT APT 1012
ARLINGTON TX
76011-2708
US

V. Phone/Fax

Practice location:
  • Phone: 817-927-3887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number703992
License Number StateTX

VIII. Authorized Official

Name: MISS ALBA ILIANA PEREZ
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 817-920-6353