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General NPI Number Information
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NPI Number | 1861717035
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Entity Type | Organization
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Legal Business Name | JGC SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 4400 ANN ARBOR RD
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City | JACKSON
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State | MI
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Zip | 49202-2814
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Country | US
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Telephone | 615-620-9303
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 ANN ARBOR RD
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City | JACKSON
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State | MI
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Zip | 49202-2814
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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 | MANAGER
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Name | RONNIE PENNELL
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Credential |
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Telephone | 615-620-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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