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General NPI Number Information
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NPI Number | 1245586536
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Entity Type | Organization
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Legal Business Name | JEB MEDICAL LLC
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1215 CLAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64116-4026
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Country | US
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Telephone | 816-695-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 CLAY ST
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City | KANSAS CITY
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State | MO
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Zip | 64116-4026
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Country | US
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Telephone | 816-695-4929
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. BRIAN A KING
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Credential |
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Telephone | 816-695-4929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LC1242724
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License Number State | MO
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