Healthcare Provider Details

I. General information

NPI: 1649384884
Provider Name (Legal Business Name): JC MEDICAL ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 KNIGHTS CT
KELLER TX
76248-5027
US

IV. Provider business mailing address

10240 KNIGHTS CT
KELLER TX
76248-5027
US

V. Phone/Fax

Practice location:
  • Phone: 817-800-8386
  • Fax: 817-295-4992
Mailing address:
  • Phone: 817-800-8386
  • Fax: 817-295-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number544119
License Number StateTX

VIII. Authorized Official

Name: CAROLYN YVONNE HACKNEY
Title or Position: BILLING MANAGER
Credential:
Phone: 817-800-8386