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General NPI Number Information
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NPI Number | 1427563329
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Entity Type | Organization
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Legal Business Name | JMC MEDICAL, LLC
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 1989 CAPITAL CIR NE STE 9
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4476
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Country | US
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Telephone | 850-524-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 10723 SYCAMORE RIDGE LN
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City | TALLAHASSEE
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State | FL
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Zip | 32305-1733
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Country | US
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Telephone | 850-524-6157
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JOSEPH MICHAEL CROOM
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Credential |
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Telephone | 850-524-6157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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