=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174929541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMC HEALTH GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2014
-----------------------------------------------------
Last Update Date | 09/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5664 BEE RIDGE RD SUITE 203
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-7546
-----------------------------------------------------
Fax | 941-955-7507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1207 OAK HAMMOCK RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-8878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-544-8995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DANIELLE MOLLER PATTI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-544-8995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------