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General NPI Number Information
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NPI Number | 1902144140
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Entity Type | Organization
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Legal Business Name | JBRC MEDICAL, LLC
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 1802 NE JENSEN BEACH BLVD
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City | JENSEN BEACH
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State | FL
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Zip | 34957-7234
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Country | US
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Telephone | 772-252-1235
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Fax | 772-252-1236
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Provider Business Mailing Address
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Address Line | 1802 NE JENSEN BEACH BLVD
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City | JENSEN BEACH
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State | FL
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Zip | 34957-7234
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Country | US
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Telephone | 772-252-1235
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Fax | 772-252-1236
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | CHRISTOPHER HALL
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Credential |
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Telephone | 772-261-3422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9104027
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 1330
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | ME61588
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 55754
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License Number State | FL
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