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General NPI Number Information
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NPI Number | 1750851085
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Entity Type | Organization
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Legal Business Name | JACOBUS ORTHOPEDICS AND INTERVENTIONAL PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 118 CLAIR DR
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City | PIEDMONT
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State | SC
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Zip | 29673-7771
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Country | US
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Telephone | 864-934-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 118 CLAIR DR
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City | PIEDMONT
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State | SC
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Zip | 29673-7771
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Country | US
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Telephone | 864-934-8787
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DR. EDDIE VAN BRIDGES
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Credential | DC
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Telephone | 864-934-8787
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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