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General NPI Number Information
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NPI Number | 1053327874
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Entity Type | Organization
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Legal Business Name | JCB ANESTHESIA & PAIN MANAGEMENT, PC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 600 EAST BLVD
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City | ELKHART
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State | IN
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Zip | 46514-2483
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Country | US
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Telephone | 574-523-3103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 700908
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City | DALLAS
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State | TX
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Zip | 75370-0908
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Country | US
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Telephone | 972-212-5858
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Fax | 214-291-5635
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE YIA-PEI CHAO
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Credential | MD
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Telephone | 260-312-2489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 50003982A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 50003982A
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License Number State | IN
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