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General NPI Number Information
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NPI Number | 1609258615
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Entity Type | Organization
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Legal Business Name | JVC MEDICAL, INC.
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 2825 PARKLAWN DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73110-4201
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Country | US
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Telephone | 405-610-8055
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Fax |
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Provider Business Mailing Address
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Address Line | 200 NW 16TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-3409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER VENGKATRAMAN COLLINS
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Credential | M.D.
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Telephone | 214-938-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 26437
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License Number State | OK
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