MEDICARE: JGA MEDICAL VENTURES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063751709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JGA MEDICAL VENTURES, P.C.

Provider Business Mailing Address
First Line	:	4798 WOODVIEW LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-4523
Country	:	US
Telephone Number	:	843-828-3352
Fax Number	:	843-357-1471

Provider Business Practice Location Address
First Line	:	4798 WOODVIEW LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-4523
Country	:	US
Telephone Number	:	843-828-3352
Fax Number	:	843-357-1471

Authorized Official
Title or Position	:	OWNER/ DOCTOR
Name	:	DR. JOSE G ARMONIO
Credential	:	MD
Telephone Number	:	843-828-3352

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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