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General NPI Number Information
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NPI Number | 1508740507
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Entity Type | Organization
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Legal Business Name | JBH PRIME LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3713 CITATION DR
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City | COLUMBIA
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State | MO
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Zip | 65202-4832
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Country | US
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Telephone | 573-217-4908
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Fax | 855-857-8425
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Provider Business Mailing Address
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Address Line | 3713 CITATION DR
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City | COLUMBIA
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State | MO
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Zip | 65202-4832
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Country | US
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Telephone | 573-217-4908
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Fax | 855-857-8425
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Authorized Official
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Title or Position | OWNER/ DAILY OPERATIONS MANAGER
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Name | JACQUELYNNE BROCKMAN
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Credential | CPT
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Telephone | 314-397-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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